=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881036770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL W. BROWN, DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2013
-----------------------------------------------------
Last Update Date | 07/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2308 HIGHWAY 367 N STE 300
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72112-2499
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-523-6574
-----------------------------------------------------
Fax | 870-523-4672
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2308 HIGHWAY 367 N STE 300
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72112-2499
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-523-6574
-----------------------------------------------------
Fax | 870-523-4672
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL W BROWN
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 870-523-6574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2148
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------