MEDICARE: DR. JEFFREY J BRINK D.D.S

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	1223G0001X	General Practice Dentistry	2901018869	MI

General Provider Information

NPI Number	:	1952490310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY J BRINK D.D.S

Provider Business Mailing Address
First Line	:	7305 E M 36
Second Line	:	SUITE A
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189-8902
Country	:	US
Telephone Number	:	810-231-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	7305 E M 36
Second Line	:	SUITE A
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189-8902
Country	:	US
Telephone Number	:	810-231-2288
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	11/04/2016

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