Provider Demographics
NPI:1689745952
Name:FIELDS, CHARLES R (DDS, MAGD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:FIELDS
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5508
Mailing Address - Country:US
Mailing Address - Phone:717-697-3400
Mailing Address - Fax:717-697-7857
Practice Address - Street 1:2101 ASPEN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5508
Practice Address - Country:US
Practice Address - Phone:717-697-3400
Practice Address - Fax:717-697-7857
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA236551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA731679OtherUNITED CONCORDIA PROVIDER