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General NPI Number Information
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NPI Number | 1114002599
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Entity Type | Organization
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Legal Business Name | DR THAD BROWN DDS
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 912 OSLER DR STE A
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City | JONESBORO
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State | AR
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Zip | 72401-4330
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Country | US
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Telephone | 870-935-0111
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Fax | 870-935-1806
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Provider Business Mailing Address
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Address Line | 912 OSLER DR STE A
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City | JONESBORO
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State | AR
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Zip | 72401-4330
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Country | US
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Telephone | 870-935-0111
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Fax | 870-935-1806
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Authorized Official
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Title or Position | DR.
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Name | DR. THAD L BROWN
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Credential |
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Telephone | 870-935-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2104
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3561
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License Number State | AR
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