Provider Demographics
NPI:1275707382
Name:FIELDS, WILLIAM JEFFREY (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JEFFREY
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 1:836 SUNSET LAKE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7554
Mailing Address - Country:US
Mailing Address - Phone:941-492-2967
Mailing Address - Fax:
Practice Address - Street 1:836 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7554
Practice Address - Country:US
Practice Address - Phone:941-492-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice