Provider Demographics
NPI:1477659761
Name:BROWER, LARAINE KAY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LARAINE
Middle Name:KAY
Last Name:BROWER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7095 WINDFIELD CT
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-636-3453
Mailing Address - Fax:810-636-3453
Practice Address - Street 1:124 N SAGINAW SUITE C
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48444
Practice Address - Country:US
Practice Address - Phone:248-634-1976
Practice Address - Fax:248-634-2414
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902004060124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist