Healthcare Provider Details

I. General information

NPI: 1437539079
Provider Name (Legal Business Name): ARIEL MARIE BROWN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 JACKSON ST
CLINTON LA
70722-3210
US

IV. Provider business mailing address

13927 HUNTLEY AVE
BATON ROUGE LA
70818-4106
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-5292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6550
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: