Basic Information
| Provider Information | |||||||||
| NPI: | 1447212931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIELDS | ||||||||
| FirstName: | JENA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FIELDS | ||||||||
| OtherFirstName: | JENA | ||||||||
| OtherMiddleName: | MONIQUE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | D.D.S. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2415 MUSGROVE RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209045200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019898994 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2415 MUSGROVE RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209045200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019898994 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 12907 | MD | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.