Provider Demographics
NPI:1376564773
Name:BROWN, WILLIAM HERBERT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HERBERT
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2012
Mailing Address - Country:US
Mailing Address - Phone:304-522-1310
Mailing Address - Fax:
Practice Address - Street 1:519 6TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2012
Practice Address - Country:US
Practice Address - Phone:304-522-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134827000Medicaid
WV2167OtherST. BOARD NUMBER
WV55-0580354OtherFEIN
WV55-0580354OtherFEIN