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NPI Code Detail

MEDICARE: DR. CAROLYN LISSAU BROWN DDS

MEDICARE: DR. CAROLYN LISSAU 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
11223D0001XPublic Health Dentistry50042CA

General Provider Information

NPI Number : 1073687034
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROLYN LISSAU BROWN DDS
Provider Business Mailing Address
First Line : 65 TERRACE DR
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94127-1527
Country : US
Telephone Number : 415-621-8056
Fax Number :
Provider Business Practice Location Address
First Line : 160 CAPP ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94110-1210
Country : US
Telephone Number : 415-621-8056
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 07/08/2007

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