Provider Demographics
NPI:1447419684
Name:HEBERT DMD, BROWN DMD & ASSOCIATES, LLC, DBA LIFESMILE DENTAL CARE
Entity Type:Organization
Organization Name:HEBERT DMD, BROWN DMD & ASSOCIATES, LLC, DBA LIFESMILE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-521-5678
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-0487
Mailing Address - Country:US
Mailing Address - Phone:314-521-5678
Mailing Address - Fax:314-521-0283
Practice Address - Street 1:8430 PERSHALL RD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3075
Practice Address - Country:US
Practice Address - Phone:314-521-5678
Practice Address - Fax:314-521-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE013034261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental