MEDICARE: AVAC 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1720827033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVAC BROWN

Provider Business Mailing Address
First Line	:	110 E MARKET ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3410
Country	:	US
Telephone Number	:	502-821-1419
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E MARKET ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3410
Country	:	US
Telephone Number	:	502-821-1419
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AARON BROWN
Credential	:	DMD
Telephone Number	:	502-821-1419

Provider Enumeration Date	:	05/24/2024
Last Update Date	:	05/24/2024

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