Provider Demographics
NPI:1073635702
Name:STEPHEN D BROWN DDS PA
Entity Type:Organization
Organization Name:STEPHEN D BROWN DDS PA
Other - Org Name:HIGHBANKS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-436-6444
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:39 GREENMEADOWS DR SOUTH
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035
Mailing Address - Country:US
Mailing Address - Phone:614-436-6444
Mailing Address - Fax:614-436-6596
Practice Address - Street 1:39 GREENMEADOWS DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035
Practice Address - Country:US
Practice Address - Phone:614-436-6444
Practice Address - Fax:614-436-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
456874OtherUNITED CONCORDIA