Healthcare Provider Details

I. General information

NPI: 1962678276
Provider Name (Legal Business Name): RODRELL S. BROWN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 GOSSETT CT
PENDLETON SC
29670-1663
US

IV. Provider business mailing address

1006 GOSSETT CT
PENDLETON SC
29670-1663
US

V. Phone/Fax

Practice location:
  • Phone: 706-719-3910
  • Fax:
Mailing address:
  • Phone: 615-424-9104
  • Fax: 615-424-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number00203058
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number600203415
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN123552
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: