Provider Demographics
NPI:1477651024
Name:BROWN, DAVID ERIC ROBERTSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC ROBERTSON
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 1:603 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5723
Mailing Address - Country:US
Mailing Address - Phone:573-686-4315
Mailing Address - Fax:573-686-7729
Practice Address - Street 1:603 POPLAR ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5723
Practice Address - Country:US
Practice Address - Phone:573-686-4315
Practice Address - Fax:573-686-7729
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist