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General NPI Number Information
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NPI Number | 1922422435
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Entity Type | Organization
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Legal Business Name | SOUTHERN DENTAL LLC
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 703 HEALTH SERVICES DR
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City | SEAFORD
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State | DE
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Zip | 19973-5784
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Country | US
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Telephone | 302-999-7600
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Fax | 302-998-6704
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Provider Business Mailing Address
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Address Line | 703 HEALTH SERVICES DR
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City | SEAFORD
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State | DE
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Zip | 19973-5784
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Country | US
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Telephone | 302-999-7600
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Fax | 302-998-6704
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL EDWIN BROWN
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Credential | DMD
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Telephone | 302-999-7600
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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 | G1-0001216
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | G1-0001011
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | G1-0001040
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License Number State | DE
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