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General NPI Number Information
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NPI Number | 1619403730
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Entity Type | Individual
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Provider Name | MATTHEW JOHN BROWN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 5685 FAR HILLS AVE
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City | DAYTON
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State | OH
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Zip | 45429-2226
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Country | US
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Telephone | 937-435-5163
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Fax |
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Provider Business Mailing Address
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Address Line | 5245 NATORP BLVD APT 400
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City | MASON
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State | OH
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Zip | 45040-2542
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Country | US
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Telephone | 614-507-1260
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.025031
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License Number State | OH
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