Provider Demographics
NPI:1700077922
Name:FINK, WILLIAM BRUCE (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRUCE
Last Name:FINK
Suffix:
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 1:106 GOLD LEAF CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9719
Mailing Address - Country:US
Mailing Address - Phone:770-331-1092
Mailing Address - Fax:770-818-5850
Practice Address - Street 1:1816 EAGLE DR STE 200-A
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8274
Practice Address - Country:US
Practice Address - Phone:770-926-0000
Practice Address - Fax:770-818-5850
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO11355122300000X, 1223D0001X
GADN011355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1700077922OtherCOMMERCIAL PAYERS