Healthcare Provider Details

I. General information

NPI: 1699918037
Provider Name (Legal Business Name): THOMAS ALLEN BROWN JR. DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 KINGSLEY AVE SUITE 1
ORANGE PARK FL
32073
US

IV. Provider business mailing address

1414 KINGSLEY AVE SUITE 1
ORANGE PARK FL
32073
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-4201
  • Fax: 904-269-1163
Mailing address:
  • Phone: 904-269-4201
  • Fax: 904-269-1163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN18370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: