Provider Demographics
NPI:1245383397
Name:FIELDS, JULIAN WILLIAM IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:WILLIAM
Last Name:FIELDS
Suffix:IV
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 1:2180 LYNCH MILL RD
Mailing Address - Street 2:
Mailing Address - City:ALTAVISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24517-1150
Mailing Address - Country:US
Mailing Address - Phone:434-369-4702
Mailing Address - Fax:434-369-4703
Practice Address - Street 1:2180 LYNCH MILL RD
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517-1150
Practice Address - Country:US
Practice Address - Phone:434-369-4702
Practice Address - Fax:434-369-4703
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA108554Medicaid