Provider Demographics
NPI:1699850594
Name:FIFIELD, JACK T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:T
Last Name:FIFIELD
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-0247
Mailing Address - Country:US
Mailing Address - Phone:606-287-8326
Mailing Address - Fax:606-287-8327
Practice Address - Street 1:US HWY 421 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:MC KEE
Practice Address - State:KY
Practice Address - Zip Code:40447
Practice Address - Country:US
Practice Address - Phone:606-287-8326
Practice Address - Fax:606-287-8327
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist