Provider Demographics
NPI:1710950621
Name:BROWN, CARRIE BELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:BELL
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13064
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40583-3064
Mailing Address - Country:US
Mailing Address - Phone:859-253-3242
Mailing Address - Fax:859-253-0025
Practice Address - Street 1:556 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1329
Practice Address - Country:US
Practice Address - Phone:859-253-3242
Practice Address - Fax:859-253-0025
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60053709Medicaid