Provider Demographics
NPI:1659591931
Name:DONALD M. BROWN D.D.S.
Entity Type:Organization
Organization Name:DONALD M. BROWN D.D.S.
Other - Org Name:CHILDREN'S DENTAL BLDG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-924-4401
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:11635 E SOUTH ST
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702
Mailing Address - Country:US
Mailing Address - Phone:562-924-4401
Mailing Address - Fax:562-924-1072
Practice Address - Street 1:11635 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90702
Practice Address - Country:US
Practice Address - Phone:562-924-4401
Practice Address - Fax:562-924-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17650122300000X, 1223P0221X
CA311741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA235777Medicaid