Provider Demographics
NPI:1346461225
Name:PATRICK AND ASHLEY FIELDS FAMILY DENTISTRY, P.A.
Entity Type:Organization
Organization Name:PATRICK AND ASHLEY FIELDS FAMILY DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-941-2482
Mailing Address - Street 1:183 ARENA RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7961
Mailing Address - Country:US
Mailing Address - Phone:501-941-2482
Mailing Address - Fax:501-941-2483
Practice Address - Street 1:183 ARENA RD
Practice Address - Street 2:SUITE C
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7961
Practice Address - Country:US
Practice Address - Phone:501-941-2482
Practice Address - Fax:501-941-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34171223G0001X
AR34331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty