Basic Information
| Provider Information | |||||||||
| NPI: | 1912524737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANDERFIN | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | MERCER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VANDERFIN | ||||||||
| OtherFirstName: | HANK | ||||||||
| OtherMiddleName: | MERCER | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8204 BUTLER RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778454150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057298218 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3011 HIGHWAY 30 W | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773403534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362940400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2020 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 37733 | TX | Y | Dental Providers | Dentist |
No ID Information.