Provider Demographics
NPI:1548434939
Name:GALEN M. FILLMORE, D.D.S.,M.S., INC.
Entity type:Organization
Organization Name:GALEN M. FILLMORE, D.D.S.,M.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FILLLMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS , MS
Authorized Official - Phone:530-894-5185
Mailing Address - Street 1:250 VALLOMBROSA AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-894-5185
Mailing Address - Fax:530-894-5184
Practice Address - Street 1:250 VALLOMBROSA AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-894-5185
Practice Address - Fax:530-894-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CGP156962OtherCALIFORNIA CHILDRE'S SERV