Healthcare Provider Details

I. General information

NPI: 1952353609
Provider Name (Legal Business Name): LAWRENCE RICKY BROWN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 SW 74TH CT STE 1610
MIAMI FL
33156-3171
US

IV. Provider business mailing address

8950 SW 74TH CT STE 1610
MIAMI FL
33156-3171
US

V. Phone/Fax

Practice location:
  • Phone: 305-670-7610
  • Fax: 305-670-4950
Mailing address:
  • Phone: 305-670-7610
  • Fax: 305-670-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: