Provider Demographics
NPI:1326487299
Name:BROWN, TROY III (DMD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:BROWN
Suffix:III
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 1:2610 BRODIE LN
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2233
Mailing Address - Country:US
Mailing Address - Phone:941-302-0862
Mailing Address - Fax:
Practice Address - Street 1:10 RIVERWOOD DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5016
Practice Address - Country:US
Practice Address - Phone:850-689-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist