Basic Information
| Provider Information | |||||||||
| NPI: | 1750576427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWNSTEIN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | NEIL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13575 W INDIAN SCHOOL RD | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | LITCHFIELD PARK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853404901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239359873 | ||||||||
| FaxNumber: | 6235366700 | ||||||||
| Practice Location | |||||||||
| Address1: | 13575 W INDIAN SCHOOL RD | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | LITCHFIELD PARK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853404901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239359873 | ||||||||
| FaxNumber: | 6235366700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2007 | ||||||||
| LastUpdateDate: | 07/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | D5164 | AZ | Y | Dental Providers | Dentist | Pediatric Dentistry |
ID Information
| ID | Type | State | Issuer | Description | 611849 | 05 | AZ | MEDICAID |