Healthcare Provider Details

I. General information

NPI: 1003104480
Provider Name (Legal Business Name): RAND BROWN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 E 9400 S SUITE 204
SANDY UT
84093-2957
US

IV. Provider business mailing address

1434 E 9400 S SUITE 204
SANDY UT
84093-2957
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-1995
  • Fax: 801-491-0393
Mailing address:
  • Phone: 801-571-1995
  • Fax: 801-491-0393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number135622
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: