Provider Demographics
NPI:1336572536
Name:FIELDS 20/20 DENTAL, LLC
Entity Type:Organization
Organization Name:FIELDS 20/20 DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-856-5050
Mailing Address - Street 1:6333 W THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-3619
Mailing Address - Country:US
Mailing Address - Phone:317-856-5050
Mailing Address - Fax:317-856-5091
Practice Address - Street 1:6333 W THOMPSON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-3619
Practice Address - Country:US
Practice Address - Phone:317-856-5050
Practice Address - Fax:317-856-5091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:20-20 DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008811A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty