Provider Demographics
NPI:1457502791
Name:DEREK JOHN BROWN DMD, MS, PA
Entity Type:Organization
Organization Name:DEREK JOHN BROWN DMD, MS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:479-273-2626
Mailing Address - Street 1:1133 N WALTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4164
Mailing Address - Country:US
Mailing Address - Phone:479-273-2626
Mailing Address - Fax:479-273-5959
Practice Address - Street 1:1133 N WALTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4164
Practice Address - Country:US
Practice Address - Phone:479-273-2626
Practice Address - Fax:479-273-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty