Provider Demographics
NPI:1881944239
Name:GREGG FINK D.M.D., INC.
Entity type:Organization
Organization Name:GREGG FINK D.M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, FICOI
Authorized Official - Phone:302-998-6300
Mailing Address - Street 1:1 CENTURIAN DR
Mailing Address - Street 2:SUITE 213
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2137
Mailing Address - Country:US
Mailing Address - Phone:302-998-6300
Mailing Address - Fax:302-998-6355
Practice Address - Street 1:1 CENTURIAN DR
Practice Address - Street 2:SUITE 213
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2137
Practice Address - Country:US
Practice Address - Phone:302-998-6300
Practice Address - Fax:302-998-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG100011651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000041575Medicaid