Provider Demographics
NPI:1497211619
Name:BROWN, AMY ODESSA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ODESSA
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ODESSA
Other - Last Name:MASHBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:715 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-3201
Mailing Address - Country:US
Mailing Address - Phone:918-287-9300
Mailing Address - Fax:918-287-3672
Practice Address - Street 1:715 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-3201
Practice Address - Country:US
Practice Address - Phone:918-287-9300
Practice Address - Fax:918-287-3672
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3612124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist