Provider Demographics
NPI:1467022194
Name:FILLEBROWN, GARRETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:FILLEBROWN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 GROVER RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04088-3445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 CANAL ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7710
Practice Address - Country:US
Practice Address - Phone:207-784-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist