Provider Demographics
NPI:1952490310
Name:BRINK, JEFFREY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
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 1:7305 E M 36
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-8902
Mailing Address - Country:US
Mailing Address - Phone:810-231-2288
Mailing Address - Fax:
Practice Address - Street 1:7305 E M 36
Practice Address - Street 2:SUITE A
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-8902
Practice Address - Country:US
Practice Address - Phone:810-231-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice