Provider Demographics
NPI:1952356552
Name:FIFIELD, JEFFREY CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:FIFIELD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 HIGHWAY 620 S
Mailing Address - Street 2:SUITE B-6
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6300
Mailing Address - Country:US
Mailing Address - Phone:512-263-0064
Mailing Address - Fax:512-263-2402
Practice Address - Street 1:1310 HIGHWAY 620 S
Practice Address - Street 2:SUITE B-6
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6300
Practice Address - Country:US
Practice Address - Phone:512-263-0064
Practice Address - Fax:512-263-2402
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist