Healthcare Provider Details

I. General information

NPI: 1558562819
Provider Name (Legal Business Name): GWENDOLYN B. BROWN,D.M.D.,L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RUTLEDGE AVE
CHARLESTON SC
29403-4145
US

IV. Provider business mailing address

700 RUTLEDGE AVE
CHARLESTON SC
29403-4145
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-9582
  • Fax: 843-723-7011
Mailing address:
  • Phone: 843-723-9582
  • Fax: 843-723-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2778
License Number StateSC

VIII. Authorized Official

Name: DR. GWENDOLYN B. BROWN
Title or Position: DENTIST OWNER
Credential: D.M.D.
Phone: 843-723-9582