MEDICARE: DR. JENNIE CAROL BROWN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7697	CO

General Provider Information

NPI Number	:	1831318062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIE CAROL BROWN DDS

Provider Business Mailing Address
First Line	:	369 IVORY CIR
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80011-9078
Country	:	US
Telephone Number	:	720-427-9518
Fax Number	:	303-755-6703

Provider Business Practice Location Address
First Line	:	1344 S CHAMBERS RD
Second Line	:	#203
City	:	AURORA
State	:	CO
Zip	:	80017-4096
Country	:	US
Telephone Number	:	303-755-6700
Fax Number	:	303-755-6703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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