=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124043328
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDD BENJAMIN FINK D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 06/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56 RETREAT AVE
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06106-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-278-0777
-----------------------------------------------------
Fax | 860-527-8806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 56 RETREAT AVE
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06106-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-278-0777
-----------------------------------------------------
Fax | 860-527-8806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 5396
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------