Provider Demographics
NPI:1487859880
Name:BROWN, THOMAS R (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3770
Mailing Address - Country:US
Mailing Address - Phone:740-264-9024
Mailing Address - Fax:740-264-7441
Practice Address - Street 1:444 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3770
Practice Address - Country:US
Practice Address - Phone:740-264-9024
Practice Address - Fax:740-264-7441
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2482684Medicaid
OH2482684Medicaid