=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003961079
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE BROWN DDS, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8737 COLESVILLE RD SUITE #301
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-3928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-587-8750
-----------------------------------------------------
Fax | 301-587-8753
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8737 COLESVILLE RD SUITE #301
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-3928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-587-8750
-----------------------------------------------------
Fax | 301-587-8753
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 9025
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------