Provider Demographics
NPI:1275601585
Name:BROWN, CHRISTOPHER R (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
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:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:IN
Mailing Address - Zip Code:47042-0685
Mailing Address - Country:US
Mailing Address - Phone:812-689-5151
Mailing Address - Fax:812-689-6303
Practice Address - Street 1:823 S ADAMS HWY 421 S
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042-0685
Practice Address - Country:US
Practice Address - Phone:812-689-5151
Practice Address - Fax:812-689-6303
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008367A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100211700AMedicaid