Provider Demographics
NPI:1811237837
Name:E JOANNE BROWN DDS PA
Entity Type:Organization
Organization Name:E JOANNE BROWN DDS PA
Other - Org Name:GREAT PLAINS FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-375-4533
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:620-375-4588
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:620-375-4588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS600361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100389050BMedicaid