Healthcare Provider Details

I. General information

NPI: 1679497077
Provider Name (Legal Business Name): FLEETWOOD FULLER BROWN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 DOERR RD 1220
APO AA
22060
US

IV. Provider business mailing address

9225 DOERR RD
APO AA
22060
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-6005
  • Fax:
Mailing address:
  • Phone: 571-231-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDGD.11547.GD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: