| NPI | 1154856870 |
|---|---|
| Doing Business As | HOWARD BROWN HEALTH 63RD ST ORAL HEALTH SERVICES |
| Entity Type | Organization |
| Authorized Contact | BURGUNDY JOHNSON Credentialing 872-629-3491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist, General Practice | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2022-06-27 |