Provider Demographics
NPI:1588931299
Name:MARY WEBB BROWN DMD, PSC
Entity type:Organization
Organization Name:MARY WEBB BROWN DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:WEBB
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-338-0606
Mailing Address - Street 1:203 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1225
Mailing Address - Country:US
Mailing Address - Phone:270-338-0606
Mailing Address - Fax:270-338-0617
Practice Address - Street 1:203 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1225
Practice Address - Country:US
Practice Address - Phone:270-338-0606
Practice Address - Fax:270-338-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437198587OtherNPI
KY60062346Medicaid
60062346OtherMEDICARE