Provider Demographics
NPI:1669462560
Name:BROWN, E. JOANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:E.
Middle Name:JOANNE
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 1:201 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEOTI
Mailing Address - State:KS
Mailing Address - Zip Code:67861-7012
Mailing Address - Country:US
Mailing Address - Phone:620-375-4533
Mailing Address - Fax:
Practice Address - Street 1:201 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LEOTI
Practice Address - State:KS
Practice Address - Zip Code:67861-7012
Practice Address - Country:US
Practice Address - Phone:620-375-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS600361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4087249102Medicaid
KS100389050BMedicare ID - Type Unspecified