Basic Information
| Provider Information | |||||||||
| NPI: | 1710008636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16525 HOLLY CREST LN | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280784909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048923300 | ||||||||
| FaxNumber: | 7048923317 | ||||||||
| Practice Location | |||||||||
| Address1: | 16525 HOLLY CREST LN | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280784909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048923300 | ||||||||
| FaxNumber: | 7048923317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 3334 | NC | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.