Provider Demographics
NPI:1699778175
Name:FIELDS, CHARLES RICHMOND (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHMOND
Last Name:FIELDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1886 METRO CENTER DR
Mailing Address - Street 2:STE 610
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5288
Mailing Address - Country:US
Mailing Address - Phone:703-689-4442
Mailing Address - Fax:703-689-0859
Practice Address - Street 1:1886 METRO CENTER DR
Practice Address - Street 2:STE 610
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5288
Practice Address - Country:US
Practice Address - Phone:703-689-4442
Practice Address - Fax:703-689-0859
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2013-05-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
VA04010072531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics