Individual
THEODORE A BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
106 3RD AVE SE, MOHALL, ND 58761
(701) 756-6655
Mailing address
P.O. BOX 188, MOHALL, ND 58761-0188
(701) 756-6655
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1760
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41000
—
ND
01
—
879031
UNITED CONCORDIA
ND
01
—
901760
DENTAL SERVICE CORPORATIO
ND
Enumeration date
10/04/2006
Last updated
07/09/2007
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