Provider Demographics
NPI:1326571027
Name:CARLA K. BRINK, D.D.S., P.C.
Entity Type:Organization
Organization Name:CARLA K. BRINK, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-996-3311
Mailing Address - Street 1:56 NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IN
Mailing Address - Zip Code:46341-8774
Mailing Address - Country:US
Mailing Address - Phone:219-996-3311
Mailing Address - Fax:219-996-6711
Practice Address - Street 1:56 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IN
Practice Address - Zip Code:46341-8774
Practice Address - Country:US
Practice Address - Phone:219-996-3311
Practice Address - Fax:219-996-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009700A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty