Provider Demographics
NPI:1407206048
Name:FIELDS, DANIEL GLENN III (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GLENN
Last Name:FIELDS
Suffix:III
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 1:221 DELMONT ST
Mailing Address - Street 2:APT 239
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405
Mailing Address - Country:UM
Mailing Address - Phone:870-761-8756
Mailing Address - Fax:
Practice Address - Street 1:7333 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2627
Practice Address - Country:US
Practice Address - Phone:423-822-8489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist