Provider Demographics
NPI:1497976906
Name:FILLMAN, DONALD WILTON (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WILTON
Last Name:FILLMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7319 NASHVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2425
Mailing Address - Country:US
Mailing Address - Phone:706-935-2206
Mailing Address - Fax:706-935-8247
Practice Address - Street 1:7319 NASHVILLE STREET
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2425
Practice Address - Country:US
Practice Address - Phone:706-935-2206
Practice Address - Fax:706-935-8247
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9179675Medicaid