Provider Demographics
NPI:1245753300
Name:KEITH BROWN DMD, INC.
Entity Type:Organization
Organization Name:KEITH BROWN DMD, INC.
Other - Org Name:BROWN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER /DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ABRAM
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-947-1219
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-0006
Mailing Address - Country:US
Mailing Address - Phone:601-947-1219
Mailing Address - Fax:601-947-9461
Practice Address - Street 1:16 PLAZA DR
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6180
Practice Address - Country:US
Practice Address - Phone:601-947-1219
Practice Address - Fax:601-947-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2663-92D122300000X
MS3948-17122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty