Provider Demographics
NPI:1780739169
Name:FAIRFIELD, KEVIN W (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:W
Last Name:FAIRFIELD
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 1:939 E PONTALUNA RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-9778
Mailing Address - Country:US
Mailing Address - Phone:231-798-9911
Mailing Address - Fax:231-799-9580
Practice Address - Street 1:939 E PONTALUNA RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-9778
Practice Address - Country:US
Practice Address - Phone:231-798-9911
Practice Address - Fax:231-799-9580
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010145621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice