Provider Demographics
NPI:1528113289
Name:BROWN, EDDIE RANDOLPH (DDS)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:RANDOLPH
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2522 PINNACLE HILLS PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1420
Mailing Address - Country:US
Mailing Address - Phone:479-254-9494
Mailing Address - Fax:479-899-6195
Practice Address - Street 1:409 HICKORY ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5448
Practice Address - Country:US
Practice Address - Phone:870-773-5520
Practice Address - Fax:870-773-4299
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR29461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice