Provider Demographics
NPI:1962628438
Name:BROWN, JERRY VERNAL (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:VERNAL
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2246
Mailing Address - Country:US
Mailing Address - Phone:801-768-8028
Mailing Address - Fax:801-768-3567
Practice Address - Street 1:588 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2246
Practice Address - Country:US
Practice Address - Phone:801-768-8028
Practice Address - Fax:801-768-3567
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1424641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice