Provider Demographics
NPI:1699180356
Name:BROWN, HEATHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
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 1:219 MALLORY CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3416
Mailing Address - Country:US
Mailing Address - Phone:540-533-4227
Mailing Address - Fax:
Practice Address - Street 1:7420 NW 5TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1611
Practice Address - Country:US
Practice Address - Phone:954-791-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040058122300000X
VA04014146951223G0001X
FLDN240161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist