Provider Demographics
NPI:1033324421
Name:JACK T. BRINKLEY, D.M.D., P.A.
Entity Type:Organization
Organization Name:JACK T. BRINKLEY, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:828-632-4292
Mailing Address - Street 1:1641 HOUCK MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-7723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:828-635-6857
Practice Address - Street 1:163 MAIN AVENUE DRIVE
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681
Practice Address - Country:US
Practice Address - Phone:828-632-4292
Practice Address - Fax:828-632-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty