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General NPI Number Information
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NPI Number | 1063788768
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Entity Type | Organization
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Legal Business Name | RYAN S. BROWN, DDS PLLC
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 3140 CLEARWATER DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-7131
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Country | US
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Telephone | 928-445-5959
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Fax | 928-445-5989
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Provider Business Mailing Address
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Address Line | 3140 CLEARWATER DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-7131
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Country | US
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Telephone | 928-445-5959
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Fax | 928-445-5989
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Authorized Official
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Title or Position | DR/OWNER
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Name | DR. RYAN S BROWN
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Credential | DDS
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Telephone | 928-445-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D6985
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License Number State | AZ
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