Provider Demographics
NPI:1659481091
Name:BROWNSON, WILLIAM JACKSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JACKSON
Last Name:BROWNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 CAMINO MIRA COSTA
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3512
Mailing Address - Country:US
Mailing Address - Phone:949-493-2391
Mailing Address - Fax:949-429-3588
Practice Address - Street 1:3553 CAMINO MIRA COSTA
Practice Address - Street 2:SUITE B
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3512
Practice Address - Country:US
Practice Address - Phone:949-493-2391
Practice Address - Fax:949-493-2391
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice