Provider Demographics
NPI:1225170855
Name:BROWN, GERALD JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JAMES
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 1:1871 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2801
Mailing Address - Country:US
Mailing Address - Phone:540-667-8165
Mailing Address - Fax:540-667-0129
Practice Address - Street 1:1871 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2801
Practice Address - Country:US
Practice Address - Phone:540-667-8165
Practice Address - Fax:540-667-0129
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist