Healthcare Provider Details

I. General information

NPI: 1336493451
Provider Name (Legal Business Name): DR. VICTOR D. BROWN, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 NILES HILL RD
COUDERSPORT PA
16915-1211
US

IV. Provider business mailing address

6 NILES HILL RD
COUDERSPORT PA
16915-1211
US

V. Phone/Fax

Practice location:
  • Phone: 814-274-1111
  • Fax: 814-274-7786
Mailing address:
  • Phone: 814-274-1111
  • Fax: 814-274-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR D BROWN
Title or Position: OWNER
Credential: DMD
Phone: 814-274-1111