Healthcare Provider Details

I. General information

NPI: 1700174927
Provider Name (Legal Business Name): CATHERINE ELIZABETH FILLMORE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE ELIZABETH PECK D.D.S.

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 MARKET ST
SUNBURY PA
17801-3411
US

IV. Provider business mailing address

335 MARKET ST
SUNBURY PA
17801-3411
US

V. Phone/Fax

Practice location:
  • Phone: 570-286-7500
  • Fax:
Mailing address:
  • Phone: 570-286-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6294
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS039337
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: