Healthcare Provider Details

I. General information

NPI: 1740339944
Provider Name (Legal Business Name): RONNIE L BROWN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W MAIN ST STE 100
ABINGDON VA
24210-2481
US

IV. Provider business mailing address

PO BOX 2045
ABINGDON VA
24212-2045
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 TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401003814
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0401003814
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401003814
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: