Provider Demographics
NPI:1598988925
Name:BROWN FAMILY ORTHODONTICS
Entity Type:Organization
Organization Name:BROWN FAMILY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:504-455-1625
Mailing Address - Street 1:100 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3050
Mailing Address - Country:US
Mailing Address - Phone:985-893-1044
Mailing Address - Fax:985-893-1270
Practice Address - Street 1:100 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3050
Practice Address - Country:US
Practice Address - Phone:985-893-1044
Practice Address - Fax:985-893-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty