Provider Demographics
NPI:1750622155
Name:BROWN, JACKLYN MICHELE (DDS)
Entity type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:MICHELE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4086 BORGE WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7377
Mailing Address - Country:US
Mailing Address - Phone:516-589-1414
Mailing Address - Fax:
Practice Address - Street 1:1304 LIBERTY PL
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:856-875-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-09
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014151361223P0221X
OH30.0259791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry