Provider Demographics
NPI:1437198587
Name:BROWN, MARY WEBB (DMD, PSC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:WEBB
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD, PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1225
Mailing Address - Country:US
Mailing Address - Phone:270-338-0606
Mailing Address - Fax:270-338-0617
Practice Address - Street 1:203 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1225
Practice Address - Country:US
Practice Address - Phone:270-338-0606
Practice Address - Fax:270-338-0617
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60062346Medicaid