Provider Demographics
NPI:1679648869
Name:FIELDER, WILLIAM JAY (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAY
Last Name:FIELDER
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 1:115 NORTH SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830
Mailing Address - Country:US
Mailing Address - Phone:432-837-5581
Mailing Address - Fax:432-837-5113
Practice Address - Street 1:115 NORTH SECOND STREET
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830
Practice Address - Country:US
Practice Address - Phone:432-837-5581
Practice Address - Fax:432-837-5113
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAF15740321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice