Healthcare Provider Details

I. General information

NPI: 1033310685
Provider Name (Legal Business Name): KERRY WHITE BROWN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ONEIL CT STE 13
COLUMBIA SC
29223-7649
US

IV. Provider business mailing address

224 ONEIL CT STE 13
COLUMBIA SC
29223-7649
US

V. Phone/Fax

Practice location:
  • Phone: 803-699-9191
  • Fax: 803-699-5936
Mailing address:
  • Phone: 803-699-9191
  • Fax: 803-699-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3358
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: