Provider Demographics
NPI:1659721181
Name:BROWN, KATHERINE (RDH)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 4100 GOSS RD
Mailing Address - Street 2:REDSTONE ARSENAL DENTAL CLINIC
Mailing Address - City:REDSTONE ARSENAL
Mailing Address - State:AL
Mailing Address - Zip Code:35809
Mailing Address - Country:US
Mailing Address - Phone:256-876-5200
Mailing Address - Fax:256-313-3238
Practice Address - Street 1:BLDG 4100 GOSS RD
Practice Address - Street 2:REDSTONE ARSENAL DENTAL CLINIC
Practice Address - City:REDSTONE ARSENAL
Practice Address - State:AL
Practice Address - Zip Code:35809
Practice Address - Country:US
Practice Address - Phone:256-876-5200
Practice Address - Fax:256-313-3238
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2308124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist