MEDICARE: ALAN BROWN DDS

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	122300000X	Dentist	6014	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	91124	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1891805974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN BROWN DDS

Provider Business Mailing Address
First Line	:	1210 EAST MARION STREET
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150
Country	:	US
Telephone Number	:	704-484-0611
Fax Number	:	704-484-6913

Provider Business Practice Location Address
First Line	:	1210 EAST MARION STREET
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150
Country	:	US
Telephone Number	:	704-484-0611
Fax Number	:	704-484-6913

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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