Provider Demographics
NPI:1447413497
Name:BROWN, CAMDEN BENTON DOUGHTIE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:CAMDEN
Middle Name:BENTON DOUGHTIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:CAMDEN
Other - Middle Name:
Other - Last Name:DOUGHTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:226 ALLIJOY ROAD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:813-857-5957
Mailing Address - Fax:
Practice Address - Street 1:1050 FORDING ISLAND RD STE F
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8667
Practice Address - Country:US
Practice Address - Phone:843-757-9760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC100661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program