Healthcare Provider Details

I. General information

NPI: 1710154943
Provider Name (Legal Business Name): THOMAS C FIELD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MOUNTAIN DR
DAHLONEGA GA
30533-1601
US

IV. Provider business mailing address

80 MOUNTAIN DR
DAHLONEGA GA
30533-1601
US

V. Phone/Fax

Practice location:
  • Phone: 706-864-5523
  • Fax: 770-538-2928
Mailing address:
  • Phone: 706-864-5523
  • Fax: 770-538-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN007715
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: