Provider Demographics
NPI:1225172059
Name:BROWN, C. DALE (DMD)
Entity Type:Individual
Prefix:DR
First Name:C.
Middle Name:DALE
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 MURANO CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-8968
Mailing Address - Country:US
Mailing Address - Phone:505-526-4649
Mailing Address - Fax:
Practice Address - Street 1:225 E IDAHO AVE STE 23
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3242
Practice Address - Country:US
Practice Address - Phone:505-524-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD13741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice