Individual
DR. CHARLES ROBERT BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
912 S RIDGEWOOD AVE, SUITE B, DAYTONA BEACH, FL 32114-5349
(386) 258-6132
(386) 239-0730
Mailing address
6211 SANTA MONICA DR, PORT ORANGE, FL 32127-5964
(386) 761-5546
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5643
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5643
DENTAL LICENSE NUMBER
FL
Enumeration date
09/24/2006
Last updated
07/09/2007
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