Provider Demographics
NPI:1558527689
Name:KENNELL P. BROWN, JR. DDS, APDC
Entity Type:Organization
Organization Name:KENNELL P. BROWN, JR. DDS, APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNELL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-369-7654
Mailing Address - Street 1:306 N LEWIS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2843
Mailing Address - Country:US
Mailing Address - Phone:337-369-7654
Mailing Address - Fax:337-367-3439
Practice Address - Street 1:306 N LEWIS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2843
Practice Address - Country:US
Practice Address - Phone:337-369-7654
Practice Address - Fax:337-367-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1835277Medicaid