MEDICARE: DR. LAWRENCE RICKY 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	11776	FL

General Provider Information

NPI Number	:	1952353609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE RICKY BROWN DDS

Provider Business Mailing Address
First Line	:	8950 SW 74TH CT
Second Line	:	STE 1610
City	:	MIAMI
State	:	FL
Zip	:	33156-3171
Country	:	US
Telephone Number	:	305-670-7610
Fax Number	:	305-670-4950

Provider Business Practice Location Address
First Line	:	8950 SW 74TH CT
Second Line	:	STE 1610
City	:	MIAMI
State	:	FL
Zip	:	33156-3171
Country	:	US
Telephone Number	:	305-670-7610
Fax Number	:	305-670-4950

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/27/2015

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