Healthcare Provider Details

I. General information

NPI: 1568642940
Provider Name (Legal Business Name): JANELLA F. BROWN ,D.M.D. PSC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 PUBLIC SQ
COLUMBIA KY
42728-1456
US

IV. Provider business mailing address

318 PUBLIC SQ
COLUMBIA KY
42728-1456
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-3481
  • Fax: 270-385-9866
Mailing address:
  • Phone: 270-384-3481
  • Fax: 270-385-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number6910
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6910
License Number StateKY

VIII. Authorized Official

Name: MS. SHEILA A. MCCLISTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-384-3481