Provider Demographics
NPI:1386634061
Name:FIELDS, GERALD LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LEE
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 1:309 S MAIN ST
Mailing Address - Street 2:P.O. BOX 107
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1810
Mailing Address - Country:US
Mailing Address - Phone:605-432-9531
Mailing Address - Fax:605-432-4830
Practice Address - Street 1:309 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1810
Practice Address - Country:US
Practice Address - Phone:605-432-9531
Practice Address - Fax:605-432-4830
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM3561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice