Provider Demographics
NPI:1912561432
Name:BILLY B BROWN JR DDS PA
Entity Type:Organization
Organization Name:BILLY B BROWN JR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:863-533-0955
Mailing Address - Street 1:695 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4615
Mailing Address - Country:US
Mailing Address - Phone:863-533-0955
Mailing Address - Fax:863-533-6468
Practice Address - Street 1:695 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4615
Practice Address - Country:US
Practice Address - Phone:863-533-0955
Practice Address - Fax:863-533-6468
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BILLY B BROWN JR DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental