Provider Demographics
NPI:1497068589
Name:BRICK, SAMUEL GONZALO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GONZALO
Last Name:BRICK
Suffix:
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 1:1915A CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2203
Mailing Address - Country:US
Mailing Address - Phone:615-327-4739
Mailing Address - Fax:
Practice Address - Street 1:451 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2842
Practice Address - Country:US
Practice Address - Phone:615-256-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice