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General NPI Number Information
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NPI Number | 1962678276
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Entity Type | Individual
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Provider Name | RODRELL S. BROWN DDS
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Gender | Male
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1795 RESURGENCE DR STE 101
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7306
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Country | US
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Telephone | 706-719-3910
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Fax |
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Provider Business Mailing Address
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Address Line | 8 UNDERHILL RD APT 6
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City | MIDDLETOWN
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State | NY
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Zip | 10940-7097
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Country | US
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Telephone | 615-424-9104
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Fax | 615-424-9104
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 00203058
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN123552
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License Number State | GA
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