MEDICARE: DR. RICHARD LEE BROWN JR. D.D.S.

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	4914	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	731521735	OTHER	OK	TAX ID #

General Provider Information

NPI Number	:	1972627008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LEE BROWN JR. D.D.S.

Provider Business Mailing Address
First Line	:	7115 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6308
Country	:	US
Telephone Number	:	918-492-1991
Fax Number	:	918-492-8690

Provider Business Practice Location Address
First Line	:	7115 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6308
Country	:	US
Telephone Number	:	918-492-1991
Fax Number	:	918-492-8690

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	11/18/2020

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