Healthcare Provider Details

I. General information

NPI: 1053380063
Provider Name (Legal Business Name): THOMAS R. BROWN, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 FRANK LAYMAN BLVD
WINTERSVILLE OH
43953-3770
US

IV. Provider business mailing address

444 FRANK LAYMAN BLVD
WINTERSVILLE OH
43953-3770
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-4493
  • Fax: 740-264-7441
Mailing address:
  • Phone: 740-264-4493
  • Fax: 740-264-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.015625
License Number StateOH

VIII. Authorized Official

Name: DR. THOMAS R. BROWN
Title or Position: PRESIDENT
Credential: D.D.S., F.A.G.D.
Phone: 740-264-4493