Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 7878 | TN |
NPI | 1033290929 |
---|---|
Provider Name | Dr. Joshua Aaron Brink SR. |
First Address | Bartlett, TN 38134-3830 |
Second Address | Bartlett, TN 38134-3830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 26/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1491320 | UNITED CONCORDIA (01) | |
2DK874 | BCBS OF MASS (01) | |
4063221 | BCBS (01) | |
5440215 | (05) | TN |
9177551 | (05) | TN |
Q013469 | (05) | TN |
Q013491 | (05) | TN |