Provider Demographics
NPI:1295000396
Name:FIKE, JEREMY WARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WARD
Last Name:FIKE
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 1:5849 BUFFALO GAP ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:325-704-5001
Mailing Address - Fax:325-704-5141
Practice Address - Street 1:5849 BUFFALO GAP ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-704-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics