Provider Demographics
NPI:1760976179
Name:FILLER, HARRISON (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:
Last Name:FILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 MOUNTAIN LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1113
Mailing Address - Country:US
Mailing Address - Phone:205-767-7651
Mailing Address - Fax:
Practice Address - Street 1:5751 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5476
Practice Address - Country:US
Practice Address - Phone:205-477-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist