Provider Demographics
NPI:1881709541
Name:BROWN, MISTY JAYE (DDS)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:JAYE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MISTY
Other - Middle Name:JAYE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:359 KELLER PKWY
Mailing Address - Street 2:BLDG B-1
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2206
Mailing Address - Country:US
Mailing Address - Phone:817-431-6995
Mailing Address - Fax:817-431-8813
Practice Address - Street 1:359 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2206
Practice Address - Country:US
Practice Address - Phone:817-431-6995
Practice Address - Fax:817-431-8813
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2795036OtherTIN