Provider Demographics
NPI:1407071129
Name:DEUINK, BRENT L (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:L
Last Name:DEUINK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CLYMER CORRY ROAD
Mailing Address - Street 2:P.O. BOX 308
Mailing Address - City:CLYMER
Mailing Address - State:NY
Mailing Address - Zip Code:14724-0308
Mailing Address - Country:US
Mailing Address - Phone:716-355-4244
Mailing Address - Fax:716-355-4244
Practice Address - Street 1:327 CLYMER-CORRY ROAD
Practice Address - Street 2:
Practice Address - City:CLYMER
Practice Address - State:NY
Practice Address - Zip Code:14724-0308
Practice Address - Country:US
Practice Address - Phone:716-355-4244
Practice Address - Fax:716-355-4244
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist