Healthcare Provider Details

I. General information

NPI: 1477694412
Provider Name (Legal Business Name): LARY JAY SCHILLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W PORTAL AVE SUITE 300
SAN FRANCISCO CA
94127-1429
US

IV. Provider business mailing address

1261 WALLER ST
SAN FRANCISCO CA
94117-2918
US

V. Phone/Fax

Practice location:
  • Phone: 415-664-4532
  • Fax: 415-664-5279
Mailing address:
  • Phone: 415-861-5545
  • Fax: 415-552-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number20461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: