Healthcare Provider Details

I. General information

NPI: 1083728596
Provider Name (Legal Business Name): JEFFREY C. BROWN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15130 STATE HWY 150 WEST
COLDSPRING TX
77331-0547
US

IV. Provider business mailing address

PO BOX 547
COLDSPRING TX
77331-0547
US

V. Phone/Fax

Practice location:
  • Phone: 936-653-4564
  • Fax: 936-653-3899
Mailing address:
  • Phone: 936-653-4564
  • Fax: 936-653-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15698
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: