Healthcare Provider Details

I. General information

NPI: 1083693261
Provider Name (Legal Business Name): ADAM J FIELDS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 COMPUTER RD SUITE L-63
WILLOW GROVE PA
19090-1752
US

IV. Provider business mailing address

2300 COMPUTER RD SUITE L-63
WILLOW GROVE PA
19090-1752
US

V. Phone/Fax

Practice location:
  • Phone: 215-659-8869
  • Fax: 215-659-8704
Mailing address:
  • Phone: 215-659-8869
  • Fax: 215-659-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS-025574-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: