Healthcare Provider Details

I. General information

NPI: 1578781571
Provider Name (Legal Business Name): BROWN DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 WEST MAIN STREET
ABINGDON VA
24210
US

IV. Provider business mailing address

915 W MAIN ST
ABINGDON VA
24210-2442
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-9507
  • Fax: 276-628-9439
Mailing address:
  • Phone: 276-628-9507
  • Fax: 276-628-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401004605
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401003814
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401410847
License Number StateVA

VIII. Authorized Official

Name: NICKIE ASHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 276-628-9507