Provider Demographics
NPI:1447466479
Name:FILLER, EVAN MARC (DMD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:MARC
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 1:50 LECH WALESA
Mailing Address - Street 2:TOM WADDELL HLTH CTR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4506
Mailing Address - Country:US
Mailing Address - Phone:415-355-7526
Mailing Address - Fax:
Practice Address - Street 1:50 LECH WALESA
Practice Address - Street 2:TOM WADDELL HC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4506
Practice Address - Country:US
Practice Address - Phone:415-355-7526
Practice Address - Fax:415-355-7408
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist