Provider Demographics
NPI:1386929271
Name:FAIRFIELD FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:FAIRFIELD FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WRENN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-815-1077
Mailing Address - Street 1:123 US HIGHWAY 321 BYP S
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-7047
Mailing Address - Country:US
Mailing Address - Phone:803-815-1077
Mailing Address - Fax:803-815-0098
Practice Address - Street 1:123 US HIGHWAY 321 BYP S
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-7047
Practice Address - Country:US
Practice Address - Phone:803-815-1077
Practice Address - Fax:803-815-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty