Healthcare Provider Details

I. General information

NPI: 1528113289
Provider Name (Legal Business Name): EDDIE RANDOLPH BROWN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 HICKORY ST
TEXARKANA AR
71854-5448
US

IV. Provider business mailing address

2522 S PINNACLE HILLS PKWY STE 104
ROGERS AR
72758-1415
US

V. Phone/Fax

Practice location:
  • Phone: 870-773-5520
  • Fax: 870-773-4299
Mailing address:
  • Phone: 479-254-9494
  • Fax: 479-899-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number33906
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2946
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2946
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: