Provider Demographics
NPI:1639513864
Name:KENNETH R FINN DMD LLC
Entity Type:Organization
Organization Name:KENNETH R FINN DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-658-9889
Mailing Address - Street 1:530 HOPMEADOW ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2415
Mailing Address - Country:US
Mailing Address - Phone:860-658-9889
Mailing Address - Fax:860-658-4713
Practice Address - Street 1:530 HOPMEADOW ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2415
Practice Address - Country:US
Practice Address - Phone:860-658-9889
Practice Address - Fax:860-658-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7385790001Medicare NSC