Provider Demographics
NPI:1689698292
Name:BRINK, CARLA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:K
Last Name:BRINK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SURREY HILL LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8077
Mailing Address - Country:US
Mailing Address - Phone:219-531-5470
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist