Provider Demographics
NPI:1215141080
Name:BROWN, JOSEPH LEONARD (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEONARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:905 S PAMPLICO HWY
Mailing Address - City:PAMPLICO
Mailing Address - State:SC
Mailing Address - Zip Code:29583
Mailing Address - Country:US
Mailing Address - Phone:843-493-2631
Mailing Address - Fax:843-493-1376
Practice Address - Street 1:905 S PAMPLICO HWY
Practice Address - Street 2:
Practice Address - City:PAMPLICO
Practice Address - State:SC
Practice Address - Zip Code:29583
Practice Address - Country:US
Practice Address - Phone:843-493-2631
Practice Address - Fax:843-493-1376
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist