Provider Demographics
NPI:1568642940
Name:JANELLA F. BROWN ,D.M.D. PSC.
Entity Type:Organization
Organization Name:JANELLA F. BROWN ,D.M.D. PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-384-3481
Mailing Address - Street 1:318 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1456
Mailing Address - Country:US
Mailing Address - Phone:270-384-3481
Mailing Address - Fax:270-385-9866
Practice Address - Street 1:318 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1456
Practice Address - Country:US
Practice Address - Phone:270-384-3481
Practice Address - Fax:270-385-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY69101223G0001X, 261QD0000X
KY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61943346Medicaid
KY45002326Medicaid