Provider Demographics
NPI:1467476564
Name:FIELDS, PATRICK D (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:D
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 1:24 SPRING ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2473
Mailing Address - Country:US
Mailing Address - Phone:501-941-2482
Mailing Address - Fax:501-941-2483
Practice Address - Street 1:24 SPRING ST
Practice Address - Street 2:SUITE A
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2473
Practice Address - Country:US
Practice Address - Phone:501-941-2482
Practice Address - Fax:501-941-2483
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149020608Medicaid