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General NPI Number Information
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NPI Number | 1073613600
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Entity Type | Individual
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Provider Name | CHARLES ROBERT BROWN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 912 S RIDGEWOOD AVE SUITE B
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5349
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Country | US
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Telephone | 386-258-6132
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Fax | 386-239-0730
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Provider Business Mailing Address
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Address Line | 6211 SANTA MONICA DR
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City | PORT ORANGE
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State | FL
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Zip | 32127-5964
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Country | US
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Telephone | 386-761-5546
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5643
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License Number State | FL
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