Provider Demographics
NPI:1710188743
Name:ROGER J. BROWN, DMD, PC
Entity Type:Organization
Organization Name:ROGER J. BROWN, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:D,MD
Authorized Official - Phone:1970-945-9499
Mailing Address - Street 1:1614 GRAND AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3859
Mailing Address - Country:US
Mailing Address - Phone:970-945-9499
Mailing Address - Fax:970-945-5134
Practice Address - Street 1:1614 GRAND AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3859
Practice Address - Country:US
Practice Address - Phone:970-945-9499
Practice Address - Fax:970-945-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71421223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty