MEDICARE: MARK C BROWNE III 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	1223G0001X	General Practice Dentistry	27589	CA

General Provider Information

NPI Number	:	1316030463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK C BROWNE III DDS

Provider Business Mailing Address
First Line	:	5995 MISSION GORGE RD
Second Line	:	STE A
City	:	SAN DIEGO
State	:	CA
Zip	:	92120
Country	:	US
Telephone Number	:	619-280-6500
Fax Number	:	619-282-4394

Provider Business Practice Location Address
First Line	:	5995 MISSION GORGE RD
Second Line	:	STE A
City	:	SAN DIEGO
State	:	CA
Zip	:	92120
Country	:	US
Telephone Number	:	619-280-6500
Fax Number	:	619-282-4394

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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