Provider Demographics
NPI:1447212931
Name:FIELDS, JENA M (DDS)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:M
Last Name:FIELDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:MONIQUE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5200
Mailing Address - Country:US
Mailing Address - Phone:301-989-8994
Mailing Address - Fax:
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5200
Practice Address - Country:US
Practice Address - Phone:301-989-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry