Provider Demographics
NPI:1083728596
Name:BROWN, JEFFREY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
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:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:COLDSPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77331-0547
Mailing Address - Country:US
Mailing Address - Phone:936-653-4564
Mailing Address - Fax:936-653-3899
Practice Address - Street 1:15130 STATE HWY 150 WEST
Practice Address - Street 2:
Practice Address - City:COLDSPRING
Practice Address - State:TX
Practice Address - Zip Code:77331-0547
Practice Address - Country:US
Practice Address - Phone:936-653-4564
Practice Address - Fax:936-653-3899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice