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General NPI Number Information
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NPI Number | 1245753300
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Entity Type | Organization
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Legal Business Name | KEITH BROWN DMD, INC.
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 16 PLAZA DR
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City | LUCEDALE
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State | MS
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Zip | 39452-6180
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Country | US
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Telephone | 601-947-1219
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Fax | 601-947-9461
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Provider Business Mailing Address
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Address Line | PO BOX 6
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City | LUCEDALE
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State | MS
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Zip | 39452-0006
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Country | US
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Telephone | 601-947-1219
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Fax | 601-947-9461
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Authorized Official
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Title or Position | OWNER /DENTIST
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Name | DR. KEITH ABRAM BROWN
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Credential | DMD
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Telephone | 601-947-1219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3948-17
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2663-92D
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License Number State | MS
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