MEDICARE: LARRY FULTON BROWDER DMD

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	3083	AL

General Provider Information

NPI Number	:	1457448359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY FULTON BROWDER DMD

Provider Business Mailing Address
First Line	:	4421 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109
Country	:	US
Telephone Number	:	334-272-2906
Fax Number	:	334-277-7278

Provider Business Practice Location Address
First Line	:	4421 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109
Country	:	US
Telephone Number	:	334-272-2906
Fax Number	:	334-277-7278

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

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

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