Provider Demographics
NPI:1407021819
Name:BROWN, WAYNE D (DDS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:BROWN
Suffix:
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 1:2332 W 12600 S
Mailing Address - Street 2:STE A
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7161
Mailing Address - Country:US
Mailing Address - Phone:801-253-4547
Mailing Address - Fax:801-302-0814
Practice Address - Street 1:2332 W 12600 S
Practice Address - Street 2:STE A
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7161
Practice Address - Country:US
Practice Address - Phone:801-253-4547
Practice Address - Fax:801-302-0814
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6219278-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist