Provider Demographics
NPI:1407206048
Name:FIELDS, DANIEL GLENN III (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:GLENN
Last Name:FIELDS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5939
Mailing Address - Country:US
Mailing Address - Phone:423-775-1464
Mailing Address - Fax:
Practice Address - Street 1:180 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5939
Practice Address - Country:US
Practice Address - Phone:423-775-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist