Provider Demographics
NPI:1609941384
Name:BROWN, RICHARD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:BROWN
Suffix:
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 1:7120 CAMPBELL RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1570
Mailing Address - Country:US
Mailing Address - Phone:972-931-7114
Mailing Address - Fax:972-931-5575
Practice Address - Street 1:7120 CAMPBELL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1570
Practice Address - Country:US
Practice Address - Phone:972-931-7114
Practice Address - Fax:972-931-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31745OtherPROVIDER ID
TX75149379OtherTAX ID NUMBER