Provider Demographics
NPI:1629250311
Name:KINGSTOWNE DENTAL CARE PC
Entity Type:Organization
Organization Name:KINGSTOWNE DENTAL CARE PC
Other - Org Name:CHARLES H BROWN III DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN III
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-719-0033
Mailing Address - Street 1:7015 A MACNHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310
Mailing Address - Country:US
Mailing Address - Phone:703-719-0033
Mailing Address - Fax:703-719-0308
Practice Address - Street 1:7015 A MACNHESTER BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310
Practice Address - Country:US
Practice Address - Phone:703-719-0033
Practice Address - Fax:703-719-0308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGSTOWNE DENTAL CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA87581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty