Healthcare Provider Details

I. General information

NPI: 1851459168
Provider Name (Legal Business Name): DAVID TAIT FINLAY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 SE OAK AVE SUITE 321
ROSEBURG OR
97470-4985
US

IV. Provider business mailing address

1012 SE OAK AVE SUITE 321
ROSEBURG OR
97470-4985
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-8702
  • Fax: 541-672-8702
Mailing address:
  • Phone: 541-672-8702
  • Fax: 541-672-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5416
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: