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General NPI Number Information
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NPI Number | 1699918037
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Entity Type | Individual
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Provider Name | THOMAS ALLEN BROWN JR. DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 1414 KINGSLEY AVE SUITE 1
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City | ORANGE PARK
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State | FL
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Zip | 32073
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Country | US
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Telephone | 904-269-4201
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Fax | 904-269-1163
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Provider Business Mailing Address
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Address Line | 1414 KINGSLEY AVE SUITE 1
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City | ORANGE PARK
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State | FL
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Zip | 32073
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Country | US
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Telephone | 904-269-4201
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Fax | 904-269-1163
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN18370
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License Number State | FL
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