Provider Demographics
NPI:1578533014
Name:BROWN, KEVIN EUGENE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EUGENE
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 16TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9213
Mailing Address - Country:US
Mailing Address - Phone:828-465-0187
Mailing Address - Fax:828-465-5680
Practice Address - Street 1:3305 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9213
Practice Address - Country:US
Practice Address - Phone:828-465-0187
Practice Address - Fax:828-465-5680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53801223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991127Medicaid
NC8991127Medicaid