Organization
JULIAN W. FIELDS D.D.S., LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIAN W. FIELDS IV D.D.S. (DENTIST/OWNER)
(434) 369-4702
Entity
Organization
Contact information
Practice address
2180 LYNCH MILL RD, ALTAVISTA, VA 24517-1150
(434) 369-4702
(434) 369-4703
Mailing address
2180 LYNCH MILL RD, ALTAVISTA, VA 24517-1150
(434) 369-4702
(434) 369-4703
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
0401007246
VA
261QD0000X
Dental Clinic/Center
Primary
0401008664
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108554
MEDICAID LOCATION NUMBER
VA
01
—
1245383397
INDIVIDUAL PROVIDER NPI
VA
01
—
1578533063
INDIVIDUAL PROVIDER NPI
VA
01
—
342746
BLUE CROSS BLUE SHIELD PROVIDER NUMBER
VA
01
—
463565
BLUE CROSS BLUE SHIELD PROVIDER NUMBER
VA
05
—
9180988
—
VA
Enumeration date
07/31/2008
Last updated
07/31/2008
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