Provider Demographics
NPI:1295579829
Name:HINKSON, BROOKLYN NICOLE (DMD)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:NICOLE
Last Name:HINKSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10007 HARLECH LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2818
Mailing Address - Country:US
Mailing Address - Phone:502-680-3614
Mailing Address - Fax:
Practice Address - Street 1:6700 SOUTHSIDE DR STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2822
Practice Address - Country:US
Practice Address - Phone:502-368-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist