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General NPI Number Information
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NPI Number | 1902826167
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Entity Type | Individual
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Provider Name | JAY DOUGLAS BROWN DMD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 6141 MID RIVERS MALL DR
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City | SAINT PETERS
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State | MO
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Zip | 63304-1105
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Country | US
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Telephone | 636-441-4600
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Fax | 636-922-2094
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Provider Business Mailing Address
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Address Line | 6141 MID RIVERS MALL DR
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City | SAINT PETERS
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State | MO
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Zip | 63304-1105
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Country | US
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Telephone | 636-441-4600
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Fax | 636-922-2094
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2010009884
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License Number State | MO
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