Provider Demographics
NPI:1487860151
Name:BROWN, BILLY BROOKS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:BROOKS
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4615
Mailing Address - Country:US
Mailing Address - Phone:863-533-0955
Mailing Address - Fax:863-533-6468
Practice Address - Street 1:695 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4615
Practice Address - Country:US
Practice Address - Phone:863-533-0955
Practice Address - Fax:863-533-6468
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7209122300000X, 1223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies