Provider Demographics
NPI:1598041121
Name:BROWN, ROSE MINDEL (RDH)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MINDEL
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PROFESSIONAL DR STE 5
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1104
Mailing Address - Country:US
Mailing Address - Phone:843-279-2309
Mailing Address - Fax:
Practice Address - Street 1:1 PROFESSIONAL DR STE 5
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1104
Practice Address - Country:US
Practice Address - Phone:843-279-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402205230124Q00000X
SC5854124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist