Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS-025574-L | PA |
NPI | 1083693261 |
---|---|
Provider Name | Dr. Adam J Fields |
First Address | Willow Grove, PA 19090-1752 |
Second Address | Willow Grove, PA 19090-1752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2006 |
Last Update Date | 08/07/2007 |