Provider Demographics
NPI:1225249352
Name:BROWN, JAMES TODD (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TODD
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 1:125 POWELL MILL RD
Mailing Address - Street 2:STE. C
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1531
Mailing Address - Country:US
Mailing Address - Phone:864-574-0788
Mailing Address - Fax:864-576-5359
Practice Address - Street 1:125 POWELL MILL RD
Practice Address - Street 2:STE. C
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1531
Practice Address - Country:US
Practice Address - Phone:864-574-0788
Practice Address - Fax:864-576-5359
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9626Medicaid
SCZX3313Medicaid