Provider Demographics
NPI:1578781571
Name:BROWN DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BROWN DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-628-9507
Mailing Address - Street 1:P.O. BOX 2045
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212
Mailing Address - Country:US
Mailing Address - Phone:276-628-9507
Mailing Address - Fax:276-628-9439
Practice Address - Street 1:915 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-628-9507
Practice Address - Fax:276-628-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004605122300000X
VA04010038141223G0001X
VA04014108471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447309836OtherNPI FOR BOB BROWN
VA9181262Medicaid
VA0016051Medicaid
VA1023125135OtherNPI FOR VICTORIA BETTIS
VA1740339944OtherNPI FOR RONNIE BROWN
VA9181261Medicaid