Healthcare Provider Details

I. General information

NPI: 1972868008
Provider Name (Legal Business Name): JEFFREY JASON BROWN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2012
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 37TH ST STE 401
VERO BEACH FL
32960-7322
US

IV. Provider business mailing address

1355 37TH ST STE 401
VERO BEACH FL
32960-7322
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-9700
  • Fax: 772-569-9704
Mailing address:
  • Phone: 772-569-9700
  • Fax: 772-569-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN20008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: