Provider Demographics
NPI:1417066275
Name:FAIRFIELD DENTAL CENTER
Entity Type:Organization
Organization Name:FAIRFIELD DENTAL CENTER
Other - Org Name:FAIRFIELD DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE DEPT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCLAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-456-9201
Mailing Address - Street 1:4800 W. FAIRFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506
Mailing Address - Country:US
Mailing Address - Phone:850-456-9201
Mailing Address - Fax:850-457-4073
Practice Address - Street 1:4800 W. FAIRFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506
Practice Address - Country:US
Practice Address - Phone:850-456-9201
Practice Address - Fax:850-457-4073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HODGE & MARTIN PA.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-29
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty