Provider Demographics
NPI:1588725915
Name:BROWN, DANIEL J (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
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 1:3235 VOLLMER RD
Mailing Address - Street 2:STE 115
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2040
Mailing Address - Country:US
Mailing Address - Phone:708-798-4499
Mailing Address - Fax:
Practice Address - Street 1:3235 VOLLMER RD
Practice Address - Street 2:STE 115
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2040
Practice Address - Country:US
Practice Address - Phone:708-798-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice