Provider Demographics
NPI:1851308720
Name:BROWN, DOUGLAS RUSSELL (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RUSSELL
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 COVINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-7406
Mailing Address - Country:US
Mailing Address - Phone:770-482-2964
Mailing Address - Fax:770-482-1396
Practice Address - Street 1:7660 COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-7406
Practice Address - Country:US
Practice Address - Phone:770-482-2964
Practice Address - Fax:770-482-1396
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist