Provider Demographics
NPI:1104047067
Name:FIELDS, ASHLEY L (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:L
Last Name:FIELDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SPRING ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2473
Mailing Address - Country:US
Mailing Address - Phone:501-941-5439
Mailing Address - Fax:501-941-2453
Practice Address - Street 1:24 SPRING ST
Practice Address - Street 2:SUITE B
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2473
Practice Address - Country:US
Practice Address - Phone:501-941-5439
Practice Address - Fax:501-941-2453
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150712608Medicaid