MEDICARE: CHARLES BROWN

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	1223G0001X	General Practice Dentistry	DN11570	FL

General Provider Information

NPI Number	:	1245390186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES BROWN

Provider Business Mailing Address
First Line	:	1770 N WICKHAM RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8122
Country	:	US
Telephone Number	:	321-253-9792
Fax Number	:

Provider Business Practice Location Address
First Line	:	9682 US HIGHWAY 19
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4642
Country	:	US
Telephone Number	:	727-842-2422
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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Directions to “ CHARLES BROWN ” Practice Location

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