Provider Demographics
NPI:1285328195
Name:DR JEREMY BROWN DMD PA
Entity type:Organization
Organization Name:DR JEREMY BROWN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-369-2255
Mailing Address - Street 1:9931 W CABLE CAR STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1269
Mailing Address - Country:US
Mailing Address - Phone:208-369-2255
Mailing Address - Fax:208-369-2256
Practice Address - Street 1:9931 W CABLE CAR STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1269
Practice Address - Country:US
Practice Address - Phone:208-369-2255
Practice Address - Fax:208-369-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental