Provider Demographics
NPI:1033290929
Name:BRINK, JOSHUA AARON SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:AARON
Last Name:BRINK
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 STAGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3830
Mailing Address - Country:US
Mailing Address - Phone:901-382-0280
Mailing Address - Fax:901-791-0955
Practice Address - Street 1:6565 STAGE RD STE 2
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3830
Practice Address - Country:US
Practice Address - Phone:901-382-0280
Practice Address - Fax:901-791-0955
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1491320OtherUNITED CONCORDIA
TNQ013469Medicaid
4063221OtherBCBS
TN9177551Medicaid
2DK874OtherBCBS OF MASS
TN5440215Medicaid
TNQ013491Medicaid