Provider Demographics
NPI:1396890810
Name:BROWN, CHARLES R (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:BROWN
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:19365 7TH AVE NE
Mailing Address - Street 2:BLDG D SUITE 108
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7441
Mailing Address - Country:US
Mailing Address - Phone:360-779-7115
Mailing Address - Fax:360-779-3990
Practice Address - Street 1:19365 7TH AVE NE
Practice Address - Street 2:BLDG D SUITE 108
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7441
Practice Address - Country:US
Practice Address - Phone:360-779-7115
Practice Address - Fax:360-779-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA49051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5003603Medicaid