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General NPI Number Information
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NPI Number | 1013804087
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Entity Type | Individual
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Provider Name | ETHAN WILLIAM BROWN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/21/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 1589 SKEET CLUB RD STE 150
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City | HIGH POINT
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State | NC
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Zip | 27265-8820
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Country | US
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Telephone | 336-450-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 725 ADELYNN LN APT 1G
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City | GREENSBORO
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State | NC
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Zip | 27409-9596
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Country | US
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Telephone | 701-521-0907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14321
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License Number State | NC
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