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General NPI Number Information
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NPI Number | 1477731743
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Entity Type | Organization
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Legal Business Name | KEISHA R. BROWN, D.D.S., P.A.
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 6213 ROCK QUARRY ROAD SUITE #110
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City | RALEIGH
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State | NC
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Zip | 27610
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Country | US
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Telephone | 919-661-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 5404 GLASS RIDGE RD
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City | RALEIGH
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State | NC
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Zip | 27616-5034
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Country | US
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Telephone | 919-981-5694
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. KEISHA RENEE BROWN
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Credential | D.D.S
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Telephone | 919-661-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7478
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License Number State | NC
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