MEDICARE: DR. GRAIG D BROWN D.D.S, M.S.

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	1223P0300X	Periodontics	1004851	AZ

General Provider Information

NPI Number	:	1497755102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRAIG D BROWN D.D.S, M.S.

Provider Business Mailing Address
First Line	:	3148 N SWAN RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1227
Country	:	US
Telephone Number	:	520-790-2151
Fax Number	:	520-790-2152

Provider Business Practice Location Address
First Line	:	3148 N SWAN RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1227
Country	:	US
Telephone Number	:	520-790-2151
Fax Number	:	520-790-2152

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	05/05/2011

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