Provider Demographics
NPI:1750506598
Name:FIELDS, R. THEODORE JR (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:R.
Middle Name:THEODORE
Last Name:FIELDS
Suffix:JR
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8226 DOUGLAS AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5943
Mailing Address - Country:US
Mailing Address - Phone:214-346-0555
Mailing Address - Fax:
Practice Address - Street 1:8226 DOUGLAS AVE STE 810
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5930
Practice Address - Country:US
Practice Address - Phone:214-346-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169611223P0106X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology