1861658726 NPI number — JULIAN W. FIELDS D.D.S., LTD.

Table of content: (NPI 1861658726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861658726 NPI number — JULIAN W. FIELDS D.D.S., LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIAN W. FIELDS D.D.S., LTD.
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:
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:
1861658726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2180 LYNCH MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAVISTA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24517-1150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-369-4702
Provider Business Mailing Address Fax Number:
434-369-4703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2180 LYNCH MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTAVISTA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24517-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-369-4702
Provider Business Practice Location Address Fax Number:
434-369-4703
Provider Enumeration Date:
07/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
JULIAN
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
434-369-4702

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  0401007246 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X , with the licence number: 0401008664 , 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)

  • Identifier: 108554 . This is a "MEDICAID LOCATION NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1245383397 . This is a "INDIVIDUAL PROVIDER NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 463565 . This is a "BLUE CROSS BLUE SHIELD PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1578533063 . This is a "INDIVIDUAL PROVIDER NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9180988 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 342746 . This is a "BLUE CROSS BLUE SHIELD PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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