Healthcare Provider Details

I. General information

NPI: 1063561215
Provider Name (Legal Business Name): DERRILL C. FINCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 S ALLEN ST
STATE COLLEGE PA
16801-5923
US

IV. Provider business mailing address

1315 S ALLEN ST
STATE COLLEGE PA
16801-5923
US

V. Phone/Fax

Practice location:
  • Phone: 814-238-4090
  • Fax: 814-234-8540
Mailing address:
  • Phone: 814-238-4090
  • Fax: 814-234-8540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS022941-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: