Provider Demographics
NPI:1780892414
Name:BROWN, JUSTIN TYLER (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:TYLER
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 1:670 SHEPARD LN STE 105
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3936
Mailing Address - Country:US
Mailing Address - Phone:801-447-2001
Mailing Address - Fax:801-447-2003
Practice Address - Street 1:670 SHEPARD LN STE 105
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3936
Practice Address - Country:US
Practice Address - Phone:801-447-2001
Practice Address - Fax:801-447-2003
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359814-99221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics