Provider Demographics
NPI:1003065285
Name:BROWN, JAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LAUREL DR
Mailing Address - Street 2:P.O. BOX 683
Mailing Address - City:HASTINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16646-5510
Mailing Address - Country:US
Mailing Address - Phone:814-247-9906
Mailing Address - Fax:814-247-6481
Practice Address - Street 1:129 LAUREL DR
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:PA
Practice Address - Zip Code:16646-5510
Practice Address - Country:US
Practice Address - Phone:814-247-9906
Practice Address - Fax:814-247-6481
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020417L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice