Provider Demographics
NPI:1750112264
Name:BROWN, LORI L (RDH)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 S 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2400
Mailing Address - Country:US
Mailing Address - Phone:816-233-5189
Mailing Address - Fax:816-344-5247
Practice Address - Street 1:904 S 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-2400
Practice Address - Country:US
Practice Address - Phone:816-233-5189
Practice Address - Fax:816-344-5247
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002529124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist