Provider Demographics
NPI:1437278686
Name:OLDFIELD, MARY E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:OLDFIELD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1504
Mailing Address - Country:US
Mailing Address - Phone:859-986-2060
Mailing Address - Fax:859-986-4978
Practice Address - Street 1:126 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1504
Practice Address - Country:US
Practice Address - Phone:859-986-2060
Practice Address - Fax:859-986-4978
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice