Gary D. Brown, D.M.D.

Individual provider Active NPI General Practice Dentistry · Paintsville, KY

NPI 1003974536 · NPPES record last updated Nov 8, 2007

Key facts

NPI
1003974536
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
5758 (KY)
Practice address
455 Main St
Paintsville, KY 41240-1056
Phone
(606) 789-5525
Fax
(606) 789-2156
NPI assigned
Dec 5, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
5758KYMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5758 KY Yes
Dentist 122300000X 5758 KY

Addresses

Primary practice location

455 Main St
Paintsville, KY 41240-1056

Mailing address

455 Main St
Paintsville, KY 41240-1056
Phone (606) 789-5525

Other identifiers

IdentifierTypeStateIssuer
45600319MedicaidKY
60057585MedicaidKY

Other providers in Paintsville, KY

All providers in Paintsville, KY · General Practice Dentistry in Kentucky

Sources for this page

Verify at the official NPI Registry.