Provider Demographics
NPI:1235804071
Name:ALLA. V. BROWN, D.M.D., P.C.
Entity Type:Organization
Organization Name:ALLA. V. BROWN, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANNAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRESTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-714-9199
Mailing Address - Street 1:5348 LANIER ISLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-9026
Mailing Address - Country:US
Mailing Address - Phone:678-714-9199
Mailing Address - Fax:678-714-9398
Practice Address - Street 1:5348 LANIER ISLANDS PKWY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-9026
Practice Address - Country:US
Practice Address - Phone:678-714-9199
Practice Address - Fax:678-714-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty