Healthcare Provider Details

I. General information

NPI: 1912090911
Provider Name (Legal Business Name): JOSEPH FREDERICK FINELLI JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 W GENESEE ST
CAMILLUS NY
13031-2352
US

IV. Provider business mailing address

5109 W GENESEE ST
CAMILLUS NY
13031-2352
US

V. Phone/Fax

Practice location:
  • Phone: 315-487-2668
  • Fax: 315-487-8661
Mailing address:
  • Phone: 315-487-2668
  • Fax: 315-487-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0382381
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: