Provider Demographics
NPI:1992781850
Name:BROWN, DALE ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:ROBERT
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 1:3434 NW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4415
Mailing Address - Country:US
Mailing Address - Phone:405-942-6734
Mailing Address - Fax:405-943-1640
Practice Address - Street 1:3434 NW 56TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4415
Practice Address - Country:US
Practice Address - Phone:405-942-6734
Practice Address - Fax:405-943-1640
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice