Active NPI
Justin Wayne Fillmore, DDS
- Pediatric Dentistry
- Yakima, WA
National Provider Identifier
1053651893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 60299331
- Practice address
- 2205 W Lincoln Ave
Yakima, WA 98902-2437 - Phone
- (509) 575-3399
- NPI assigned
- Feb 14, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 60299331 | WA | Primary |
Addresses
Primary practice location
2205 W Lincoln Ave
Yakima, WA 98902-2437
Mailing address
210 S 66TH Ave # 2
Yakima, WA 98908-1722
Phone (801) 448-4283
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60299331 | WA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360800000000",
"number": "1053651893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 S 66TH AVE # 2",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989081722",
"telephone_number": "801-448-4283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2205 W LINCOLN AVE",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989022437",
"telephone_number": "509-575-3399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FILLMORE",
"first_name": "JUSTIN",
"middle_name": "WAYNE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-02-14",
"last_updated": "2013-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "WA",
"license": "60299331",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.