Provider Demographics
NPI:1629081880
Name:BROWN, DOUGLAS M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:BROWN
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:540 W BASELINE RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1612
Mailing Address - Country:US
Mailing Address - Phone:909-626-8501
Mailing Address - Fax:909-624-3582
Practice Address - Street 1:540 W BASELINE RD
Practice Address - Street 2:SUITE 12
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1612
Practice Address - Country:US
Practice Address - Phone:909-626-8501
Practice Address - Fax:909-624-3582
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA295641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics