Healthcare Provider Details

I. General information

NPI: 1962729046
Provider Name (Legal Business Name): BENJAMAN ROY BROWN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W FRANCIS AVE STE 102
SPOKANE WA
99205-6348
US

IV. Provider business mailing address

123 W FRANCIS AVE STE 102
SPOKANE WA
99205-6348
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-8800
  • Fax: 509-321-0154
Mailing address:
  • Phone: 509-928-8800
  • Fax: 509-321-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number61150363
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: