MEDICARE: HENRY MERCER VANDERFIN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	37733	TX

General Provider Information

NPI Number	:	1912524737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY MERCER VANDERFIN DMD

Provider Business Mailing Address
First Line	:	8204 BUTLER RIDGE DR
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-4150
Country	:	US
Telephone Number	:	805-729-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	3011 HIGHWAY 30 W
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-3534
Country	:	US
Telephone Number	:	936-294-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	08/25/2021

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