Provider Demographics
NPI:1619083748
Name:FIELD, ROBERT DAVIS (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVIS
Last Name:FIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:R
Other - Middle Name:D
Other - Last Name:FIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PA
Mailing Address - Street 1:848 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4905
Mailing Address - Country:US
Mailing Address - Phone:662-844-8000
Mailing Address - Fax:662-844-9479
Practice Address - Street 1:848 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4905
Practice Address - Country:US
Practice Address - Phone:662-844-8000
Practice Address - Fax:662-844-9479
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1235-66122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T21214Medicare UPIN