Provider Demographics
NPI:1386496313
Name:DR. LAURIE M. BROWN, PEDIATRIC DENTISTRY, PC
Entity type:Organization
Organization Name:DR. LAURIE M. BROWN, PEDIATRIC DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:413-525-6626
Mailing Address - Street 1:52 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2321
Mailing Address - Country:US
Mailing Address - Phone:413-525-6626
Mailing Address - Fax:413-525-1164
Practice Address - Street 1:52 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2321
Practice Address - Country:US
Practice Address - Phone:413-525-6626
Practice Address - Fax:413-525-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental