MEDICARE: KAROL 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	19495	TX

General Provider Information

NPI Number	:	1720146491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAROL BROWN

Provider Business Mailing Address
First Line	:	650 INTERNATIONAL PKWY
Second Line	:	SUITE 100
City	:	RICHARDSON
State	:	TX
Zip	:	75081-6612
Country	:	US
Telephone Number	:	214-331-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	3235 W CAMP WISDOM RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2605
Country	:	US
Telephone Number	:	214-331-1131
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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