Provider Demographics
NPI:1093962912
Name:BROWN, JENNIFER R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 LYNCH LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-2234
Mailing Address - Country:US
Mailing Address - Phone:812-288-1066
Mailing Address - Fax:812-285-0090
Practice Address - Street 1:1516 LYNCH LN
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2234
Practice Address - Country:US
Practice Address - Phone:812-288-1066
Practice Address - Fax:812-285-0090
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011210A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist