Healthcare Provider Details

I. General information

NPI: 1295190742
Provider Name (Legal Business Name): SHAWN H BROWN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N MAIN ST SUITE 301
CEDAR CITY UT
84720-2678
US

IV. Provider business mailing address

PO BOX 1110
CEDAR CITY UT
84721-1110
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-3885
  • Fax:
Mailing address:
  • Phone: 435-586-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4744889-992
License Number StateUT

VIII. Authorized Official

Name: SHAWN BROWN
Title or Position: OWNER
Credential:
Phone: 435-586-3885