Carla K Brink, D.D.S.
Individual provider Active NPI Dentist · Hebron, IN
NPI 1689698292 · NPPES record last updated Jan 4, 2010
Key facts
- NPI
- 1689698292
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12009700 (IN)
- Practice address
- 56 Nichols St
Hebron, IN 46341-8774 - Phone
- (219) 996-3311
- Fax
- (219) 996-6711
- NPI assigned
- Jul 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12009700 | IN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12009700 | IN | Yes |
Addresses
Primary practice location
56 Nichols St
Hebron, IN 46341-8774
Mailing address
465 Surrey Hill LN
Valparaiso, IN 46385-8077
Phone (219) 531-5470
Other providers in Hebron, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.