Provider Demographics
NPI:1366674541
Name:BROWN, VERONICA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
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 879
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-0879
Mailing Address - Country:US
Mailing Address - Phone:304-732-8486
Mailing Address - Fax:304-732-6667
Practice Address - Street 1:RT. 103 SUPPLY STREET
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:WV
Practice Address - Zip Code:24836
Practice Address - Country:US
Practice Address - Phone:304-448-2101
Practice Address - Fax:304-448-3217
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015795Medicaid