Provider Demographics
NPI:1609961580
Name:FIELDEN, SAMUEL CODY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CODY
Last Name:FIELDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-2844
Mailing Address - Country:US
Mailing Address - Phone:336-886-8071
Mailing Address - Fax:336-889-6016
Practice Address - Street 1:115 GATEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4944
Practice Address - Country:US
Practice Address - Phone:336-889-2434
Practice Address - Fax:336-889-6016
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice