Individual provider · NPI-1

Dr. Justin David Brown, D.D.S.

Dentist, General Practice · Peru, IN

NPI number1013110568
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1013110568
Entity type
Individual (NPI-1)
Name
Dr. Justin David Brown
Credential
D.D.S.
Sex
Male
Sole proprietor
No
Enumeration date
Jun 11, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice12010988AINYes

Practice location

5 Logan St
Peru, IN 46970-1642

Phone 765-473-9336 · Fax 765-473-9346

Mailing address

366 W 12th St
Peru, IN 46970-1549

Phone 765-461-5437

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