Provider Demographics
NPI:1942392881
Name:FIELDS COSMETIC & FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:FIELDS COSMETIC & FAMILY DENTISTRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-227-7110
Mailing Address - Street 1:170 CHANGEBRIDGE RD
Mailing Address - Street 2:SUITE C-1A
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9115
Mailing Address - Country:US
Mailing Address - Phone:973-227-7110
Mailing Address - Fax:973-227-7118
Practice Address - Street 1:170 CHANGEBRIDGE RD
Practice Address - Street 2:SUITE C-1A
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9115
Practice Address - Country:US
Practice Address - Phone:973-227-7110
Practice Address - Fax:973-227-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0216151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty