Provider Demographics
NPI:1922021534
Name:BROWN, RICHARD ALLEN (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1024
Mailing Address - Country:US
Mailing Address - Phone:860-267-9904
Mailing Address - Fax:860-267-7270
Practice Address - Street 1:41 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1024
Practice Address - Country:US
Practice Address - Phone:860-267-9904
Practice Address - Fax:860-267-7270
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice