Provider Demographics
NPI:1073555942
Name:FIELDS, BRYAN SOLOMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:SOLOMON
Last Name:FIELDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 N 5TH ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2746
Mailing Address - Country:US
Mailing Address - Phone:580-762-5624
Mailing Address - Fax:
Practice Address - Street 1:1618 N 5TH ST
Practice Address - Street 2:STE. 2
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2746
Practice Address - Country:US
Practice Address - Phone:580-762-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5424OtherSTATE LICENSE