Provider Demographics
NPI:1538237425
Name:BROWN, KERRY JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:JAMES
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 1:2025 W LONG LAKE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4100
Mailing Address - Country:US
Mailing Address - Phone:248-641-9490
Mailing Address - Fax:
Practice Address - Street 1:2025 W LONG LAKE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-4100
Practice Address - Country:US
Practice Address - Phone:248-641-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist