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General NPI Number Information
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NPI Number | 1972532398
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Entity Type | Individual
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Provider Name | CHARLES BERNARD BROWN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 58 8TH AVE
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City | CARBONDALE
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State | PA
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Zip | 18407-2297
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Country | US
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Telephone | 570-282-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 58 8TH AVE
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City | CARBONDALE
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State | PA
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Zip | 18407-2297
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Country | US
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Telephone | 570-282-4262
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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 | DS020132L
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License Number State | PA
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