Provider Demographics
NPI:1326489345
Name:BROWN, EDWARD VICTOR III (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:VICTOR
Last Name:BROWN
Suffix:III
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15465 OAK LN
Mailing Address - Street 2:SUITE 100H
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2663
Mailing Address - Country:US
Mailing Address - Phone:228-832-4450
Mailing Address - Fax:
Practice Address - Street 1:15465 OAK LN
Practice Address - Street 2:SUITE 100H
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2663
Practice Address - Country:US
Practice Address - Phone:228-832-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3502-091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics