Provider Demographics
NPI:1649684721
Name:TIMOTHY S. BROWN D.D.S., PA
Entity type:Organization
Organization Name:TIMOTHY S. BROWN D.D.S., PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-637-8396
Mailing Address - Street 1:513 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1123
Mailing Address - Country:US
Mailing Address - Phone:507-637-8396
Mailing Address - Fax:507-627-8894
Practice Address - Street 1:513 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1123
Practice Address - Country:US
Practice Address - Phone:507-637-8396
Practice Address - Fax:507-627-8894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIMOTHY S. BROWN D.S.S., PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty