1699778175 NPI number — DR. CHARLES RICHMOND FIELDS DMD

Table of content: DR. CHARLES RICHMOND FIELDS DMD (NPI 1699778175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699778175 NPI number — DR. CHARLES RICHMOND FIELDS DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIELDS
Provider First Name:
CHARLES
Provider Middle Name:
RICHMOND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699778175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/17/2006
NPI Reactivation Date:
03/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1886 METRO CENTER DR
Provider Second Line Business Mailing Address:
STE 610
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20190-5288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-689-4442
Provider Business Mailing Address Fax Number:
703-689-0859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1886 METRO CENTER DR
Provider Second Line Business Practice Location Address:
STE 610
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-5288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-689-4442
Provider Business Practice Location Address Fax Number:
703-689-0859
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  0401007253 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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