Provider Demographics
NPI:1639456825
Name:BROWN, JACQUELINE JOHNETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JOHNETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W LEIGH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3200
Mailing Address - Country:US
Mailing Address - Phone:804-648-2020
Mailing Address - Fax:804-782-2215
Practice Address - Street 1:505 W LEIGH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3200
Practice Address - Country:US
Practice Address - Phone:804-648-2020
Practice Address - Fax:804-782-2215
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist