Individual
JUSTIN WAYNE FILLMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2205 W LINCOLN AVE, YAKIMA, WA 98902-2437
(509) 575-3399
Mailing address
210 S 66TH AVE # 2, YAKIMA, WA 98908-1722
(801) 448-4283
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
60299331
WA
Other
Enumeration date
02/14/2013
Last updated
02/14/2013
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