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General NPI Number Information
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NPI Number | 1326571027
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Entity Type | Organization
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Legal Business Name | CARLA K. BRINK, D.D.S., P.C.
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 56 NICHOLS ST
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City | HEBRON
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State | IN
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Zip | 46341-8774
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Country | US
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Telephone | 219-996-3311
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Fax | 219-996-6711
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Provider Business Mailing Address
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Address Line | 56 NICHOLS ST
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City | HEBRON
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State | IN
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Zip | 46341-8774
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Country | US
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Telephone | 219-996-3311
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Fax | 219-996-6711
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Authorized Official
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Title or Position | OWNER
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Name | CARLA K BRINK
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Credential | D.D.S.
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Telephone | 219-996-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12009700A
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License Number State | IN
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