Provider Demographics
NPI:1851656615
Name:BROWN, LORI MILLER (RDH, MS)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MILLER
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 S ANKENY BLVD
Mailing Address - Street 2:BUILDING 9
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8995
Mailing Address - Country:US
Mailing Address - Phone:515-964-6309
Mailing Address - Fax:515-964-6602
Practice Address - Street 1:2006 S ANKENY BLVD
Practice Address - Street 2:BUILDING 9
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8995
Practice Address - Country:US
Practice Address - Phone:515-964-6309
Practice Address - Fax:515-964-6602
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1258124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist