Healthcare Provider Details

I. General information

NPI: 1861604670
Provider Name (Legal Business Name): RONALD BROWN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 02/08/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 SYCAMORE
MANTECA CA
95222-1215
US

IV. Provider business mailing address

2376 SHADOW BERRY DR P
MANTECA CA
95336-5131
US

V. Phone/Fax

Practice location:
  • Phone: 209-823-2165
  • Fax:
Mailing address:
  • Phone: 209-815-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: