Provider Demographics
NPI:1427145366
Name:BRINKER, C MICHAEL (DMD PSC)
Entity type:Individual
Prefix:MR
First Name:C
Middle Name:MICHAEL
Last Name:BRINKER
Suffix:
Gender:M
Credentials:DMD PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8172 MALL ROAD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:859-525-2257
Mailing Address - Fax:859-282-4372
Practice Address - Street 1:8172 MALL ROAD
Practice Address - Street 2:SUITE 214
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-525-2257
Practice Address - Fax:859-282-4372
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4315204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery