MEDICARE: BRIDGET MCDOWELL BROWN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401412161	VA

General Provider Information

NPI Number	:	1043472863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET MCDOWELL BROWN DDS

Provider Business Mailing Address
First Line	:	1075 BROOK RUN RD
Second Line	:
City	:	HALIFAX
State	:	VA
Zip	:	24558-3005
Country	:	US
Telephone Number	:	434-713-0992
Fax Number	:	434-517-8367

Provider Business Practice Location Address
First Line	:	101 AUBREYS LOOP STE C
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-5054
Country	:	US
Telephone Number	:	434-517-8361
Fax Number	:	434-517-8367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	01/21/2016

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