MEDICARE: CHRISTINE BROWN DMD, LLC

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	D7957	OR

General Provider Information

NPI Number	:	1699866624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINE BROWN DMD, LLC

Provider Business Mailing Address
First Line	:	2423 SW VERMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-1939
Country	:	US
Telephone Number	:	503-246-7700
Fax Number	:	503-296-5339

Provider Business Practice Location Address
First Line	:	2423 SW VERMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-1939
Country	:	US
Telephone Number	:	503-246-7700
Fax Number	:	503-296-5339

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARY CHRISTINE BROWN
Credential	:	D.M.D.
Telephone Number	:	503-246-7700

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/22/2020

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