Provider Demographics
NPI:1497883995
Name:FILLMAN, MICHAEL J (DDS MS MPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FILLMAN
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Gender:M
Credentials:DDS MS MPH
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Mailing Address - Street 1:33699 YUCAIPA BLVD
Mailing Address - Street 2:#1-E
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2039
Mailing Address - Country:US
Mailing Address - Phone:909-790-7799
Mailing Address - Fax:909-790-2077
Practice Address - Street 1:33699 YUCAIPA BLVD
Practice Address - Street 2:#1-E
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2039
Practice Address - Country:US
Practice Address - Phone:909-790-7799
Practice Address - Fax:909-790-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA0242241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics