Healthcare Provider Details

I. General information

NPI: 1366728784
Provider Name (Legal Business Name): DR. KIMBERLY BROWN, DMD, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 E HIGHWAY 192 BYP
LONDON KY
40741-3123
US

IV. Provider business mailing address

PO BOX 1359
LONDON KY
40743-1359
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-6680
  • Fax: 606-864-7310
Mailing address:
  • Phone: 606-864-6680
  • Fax: 606-864-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6688
License Number StateKY

VIII. Authorized Official

Name: DR. KIMBERLY BROWN
Title or Position: OWNER
Credential: D.M.D.
Phone: 606-864-6680