Provider Demographics
NPI:1437291630
Name:BROWN, BRANDON R (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1612 LANCASTER DR
Mailing Address - Street 2:STE 445
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3544
Mailing Address - Country:US
Mailing Address - Phone:817-329-4979
Mailing Address - Fax:817-488-4483
Practice Address - Street 1:440 W INTERSTATE HWY 635
Practice Address - Street 2:#445
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3811
Practice Address - Country:US
Practice Address - Phone:972-401-8301
Practice Address - Fax:972-444-8265
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527161223S0112X
TX231791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6641Medicare PIN