Provider Demographics
NPI:1083837959
Name:H. D. BROWN, D.D.S., INC.
Entity Type:Organization
Organization Name:H. D. BROWN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-992-2878
Mailing Address - Street 1:200 W MAIN ST
Mailing Address - Street 2:P.O. BOX 704
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769-1287
Mailing Address - Country:US
Mailing Address - Phone:740-992-2878
Mailing Address - Fax:740-992-5390
Practice Address - Street 1:200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-1287
Practice Address - Country:US
Practice Address - Phone:740-992-2878
Practice Address - Fax:740-992-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0119631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-0853967-026OtherCARESOURCE PAYMENT NO.
OH2241514Medicaid
OH9180660OtherDORAL PAYMENT NO.