Provider Demographics
NPI:1801010970
Name:BRINK, THOMAS LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:BRINK
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 1:24 S MAIN ST
Mailing Address - Street 2:PO BOX 195
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14737-1220
Mailing Address - Country:US
Mailing Address - Phone:716-676-3637
Mailing Address - Fax:716-676-2497
Practice Address - Street 1:24 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NY
Practice Address - Zip Code:14737-1220
Practice Address - Country:US
Practice Address - Phone:716-676-3637
Practice Address - Fax:716-676-2497
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0303211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice