MEDICARE: JEANINE M FILLMANN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12009865	IN

General Provider Information

NPI Number	:	1023175213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANINE M FILLMANN DDS

Provider Business Mailing Address
First Line	:	3610 N BRIARWOOD LN
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-5219
Country	:	US
Telephone Number	:	765-289-1578
Fax Number	:	765-289-7901

Provider Business Practice Location Address
First Line	:	3610 N BRIARWOOD LN
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-5219
Country	:	US
Telephone Number	:	765-289-1578
Fax Number	:	765-289-7901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	10/19/2016

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