Healthcare Provider Details

I. General information

NPI: 1366674541
Provider Name (Legal Business Name): VERONICA MARIE BROWN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT. 103 SUPPLY STREET
GARY WV
24836
US

IV. Provider business mailing address

PO BOX 879
PINEVILLE WV
24874-0879
US

V. Phone/Fax

Practice location:
  • Phone: 304-448-2101
  • Fax: 304-448-3217
Mailing address:
  • Phone: 304-732-8486
  • Fax: 304-732-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3887
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: