Provider Demographics
NPI:1780755165
Name:BROWN, EUGENE C JR (DDS, MS, PA)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:C
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5800 RIDGEWOOD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2667
Mailing Address - Country:US
Mailing Address - Phone:160-195-7171
Mailing Address - Fax:601-956-8774
Practice Address - Street 1:5800 RIDGEWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2667
Practice Address - Country:US
Practice Address - Phone:160-195-7171
Practice Address - Fax:601-956-8774
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1777-771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660282Medicaid