1841698883 NPI number — DARRYL A. FIELD, DDS, PA, LLC

Table of content: (NPI 1841698883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841698883 NPI number — DARRYL A. FIELD, DDS, PA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARRYL A. FIELD, DDS, PA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1841698883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1361 13TH AVE S STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32250-3236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-273-4373
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1361 13TH AVE S STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32250-3236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-273-4373
Provider Business Practice Location Address Fax Number:
904-242-8747
Provider Enumeration Date:
12/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HOUGLAND
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
904-273-4373

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  DN14294 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1801982145 . This is a "DENTIST, PERIODONTITIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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