Justin David Brown, D.D.S.
Individual provider Active NPI General Practice Dentistry · Peru, IN
NPI 1013110568 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1013110568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12010988A (IN)
- Practice address
- 5 Logan St
Peru, IN 46970-1642 - Phone
- (765) 473-9336
- Fax
- (765) 473-9346
- NPI assigned
- Jun 11, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171205001719 | IN | Order and Referring Only - Dentist |
9032414958 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Justin Brown DDS LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12010988A | IN | Yes |
Addresses
Primary practice location
5 Logan St
Peru, IN 46970-1642
Mailing address
366 W 12TH St
Peru, IN 46970-1549
Phone (765) 461-5437
Other providers in Peru, IN
- Lisa Anne Boothby
- Bower Family Dentistry
- Skye Bower
- Marikay Boylan
- Amanda Kay Broughton
- Michael John Brumfield
- Rena Lynn Bryson
- Megan Renee Bullins
- Nicole Rae Burkhart
- Ashton Burton
All providers in Peru, IN · General Practice Dentistry in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.