=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891089488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAUREN BROWNFIELD, DDS, MS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2011
-----------------------------------------------------
Last Update Date | 06/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6410 FANNIN ST SUITE 1512
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-790-0288
-----------------------------------------------------
Fax | 713-790-0289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1407 SOUTHMORE BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004-5845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-790-0288
-----------------------------------------------------
Fax | 713-790-0289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LAUREN BROWNFIELD
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 713-790-0288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 23484
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------