Provider Demographics
NPI:1700030947
Name:FILL, DORIS N/A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:N/A
Last Name:FILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-3014
Mailing Address - Country:US
Mailing Address - Phone:619-262-0706
Mailing Address - Fax:
Practice Address - Street 1:5060 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3014
Practice Address - Country:US
Practice Address - Phone:619-262-0706
Practice Address - Fax:619-262-4307
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist