Healthcare Provider Details

I. General information

NPI: 1801010970
Provider Name (Legal Business Name): THOMAS LAWRENCE BRINK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S MAIN ST
FRANKLINVILLE NY
14737-1220
US

IV. Provider business mailing address

24 S MAIN ST PO BOX 195
FRANKLINVILLE NY
14737-1220
US

V. Phone/Fax

Practice location:
  • Phone: 716-676-3637
  • Fax: 716-676-2497
Mailing address:
  • Phone: 716-676-3637
  • Fax: 716-676-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number030321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: