Provider Demographics
NPI:1700174927
Name:FILLMORE, CATHERINE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:FILLMORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:335 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-3411
Mailing Address - Country:US
Mailing Address - Phone:570-286-7500
Mailing Address - Fax:
Practice Address - Street 1:335 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-3411
Practice Address - Country:US
Practice Address - Phone:570-286-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0393371223P0221X
OK62941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102853725Medicaid