Healthcare Provider Details

I. General information

NPI: 1295959146
Provider Name (Legal Business Name): DEXTER B BROWN DDS MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N DELAWARE ST
KENNEWICK WA
99336-7702
US

IV. Provider business mailing address

306 N DELAWARE ST
KENNEWICK WA
99336
US

V. Phone/Fax

Practice location:
  • Phone: 509-735-7591
  • Fax: 509-783-5815
Mailing address:
  • Phone: 509-735-7591
  • Fax: 509-783-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00003667
License Number StateWA

VIII. Authorized Official

Name: DR. DEXTER B BROWN
Title or Position: OWNER
Credential: DDS MS
Phone: 509-735-7591