Provider Demographics
NPI:1326440546
Name:JULIAN FIELDS, DDS LTD
Entity Type:Organization
Organization Name:JULIAN FIELDS, DDS LTD
Other - Org Name:ALTAVISTA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-369-4702
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty