Provider Demographics
NPI:1225282635
Name:BROWN, BENJAMIN BURTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BURTON
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:632 13TH ST.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-529-6636
Mailing Address - Fax:304-529-6618
Practice Address - Street 1:632 13TH ST.
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-529-6636
Practice Address - Fax:304-529-6618
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV3443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist