Provider Demographics
NPI:1366507378
Name:FINK, RICHARD LEROY (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEROY
Last Name:FINK
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 1:122 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-4104
Mailing Address - Country:US
Mailing Address - Phone:406-433-4422
Mailing Address - Fax:406-433-2109
Practice Address - Street 1:122 2ND ST SE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4104
Practice Address - Country:US
Practice Address - Phone:406-433-4422
Practice Address - Fax:406-433-2109
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0120952Medicaid
ND41152Medicaid