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General NPI Number Information
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NPI Number | 1770967028
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Entity Type | Organization
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Legal Business Name | CALVIN C BROWN JR DDS PLLC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 08/13/2015
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Provider Practice Location Address
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Address Line | 23105 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48089-1622
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Country | US
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Telephone | 586-759-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 19226 SILVER SPRING DR 204
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City | NORTHVILLE
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State | MI
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Zip | 48167-2539
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CALVIN BROWN JR.
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Credential | DDS
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Telephone | 586-759-5353
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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 | 2901017246
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License Number State | MI
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