Healthcare Provider Details

I. General information

NPI: 1295000396
Provider Name (Legal Business Name): JEREMY WARD FIKE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5849 BUFFALO GAP ROAD SUITE C
ABILENE TX
79606
US

IV. Provider business mailing address

5849 BUFFALO GAP ROAD SUITE C
ABILENE TX
79606
US

V. Phone/Fax

Practice location:
  • Phone: 325-704-5001
  • Fax:
Mailing address:
  • Phone: 325-704-5001
  • Fax: 325-704-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number26519
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: