Provider Demographics
NPI:1558594580
Name:FILLAK, PAULA SUSAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:SUSAN
Last Name:FILLAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10805 OAKTON CT
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8541
Mailing Address - Country:US
Mailing Address - Phone:815-922-7342
Mailing Address - Fax:
Practice Address - Street 1:25214 W REED ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410
Practice Address - Country:US
Practice Address - Phone:815-922-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist