Healthcare Provider Details

I. General information

NPI: 1477659761
Provider Name (Legal Business Name): LARAINE KAY BROWER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N SAGINAW SUITE C
HOLLY MI
48444
US

IV. Provider business mailing address

7095 WINDFIELD CT
GRAND BLANC MI
48439
US

V. Phone/Fax

Practice location:
  • Phone: 248-634-1976
  • Fax: 248-634-2414
Mailing address:
  • Phone: 810-636-3453
  • Fax: 810-636-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902004060
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: