Provider Demographics
NPI:1861658726
Name:JULIAN W. FIELDS D.D.S., LTD.
Entity Type:Organization
Organization Name:JULIAN W. FIELDS D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-369-4702
Mailing Address - Street 1:2180 LYNCH MILL RD
Mailing Address - Street 2:
Mailing Address - City:ALTAVISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24517-1150
Mailing Address - Country:US
Mailing Address - Phone:434-369-4702
Mailing Address - Fax:434-369-4703
Practice Address - Street 1:2180 LYNCH MILL RD
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517-1150
Practice Address - Country:US
Practice Address - Phone:434-369-4702
Practice Address - Fax:434-369-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008664261QD0000X
VA0401007246261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA108554OtherMEDICAID LOCATION NUMBER
VA1245383397OtherINDIVIDUAL PROVIDER NPI
VA463565OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
VA1578533063OtherINDIVIDUAL PROVIDER NPI
VA9180988Medicaid
VA342746OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER