Provider Demographics
NPI:1295195899
Name:HEALTHY EXPRESSIONS DENTAL
Entity Type:Organization
Organization Name:HEALTHY EXPRESSIONS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-684-3736
Mailing Address - Street 1:181 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2801
Mailing Address - Country:US
Mailing Address - Phone:509-684-3736
Mailing Address - Fax:509-684-3407
Practice Address - Street 1:181 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2801
Practice Address - Country:US
Practice Address - Phone:509-684-3736
Practice Address - Fax:509-684-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty