Healthcare Provider Details

I. General information

NPI: 1699925735
Provider Name (Legal Business Name): JANNIECE BROWN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 ATLANTA HWY
MONTGOMERY AL
36117-5521
US

IV. Provider business mailing address

11101 ATLANTA HWY
MONTGOMERY AL
36117-5521
US

V. Phone/Fax

Practice location:
  • Phone: 334-887-9964
  • Fax: 334-887-9964
Mailing address:
  • Phone: 334-887-9964
  • Fax: 334-887-9964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number3914
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3914
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3914
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: