Provider Demographics
NPI:1083843551
Name:BROWN, JASON REID (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:REID
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 EASY ST
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-2427
Mailing Address - Country:US
Mailing Address - Phone:662-746-1432
Mailing Address - Fax:662-746-5974
Practice Address - Street 1:1615 EASY ST
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2427
Practice Address - Country:US
Practice Address - Phone:662-746-1432
Practice Address - Fax:662-746-5974
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3507-09122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist