Provider Demographics
NPI:1760512339
Name:BROWNSCOMBE, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BROWNSCOMBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24055 JEFFERSON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1511
Mailing Address - Country:US
Mailing Address - Phone:586-773-1050
Mailing Address - Fax:586-773-2059
Practice Address - Street 1:24055 JEFFERSON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1511
Practice Address - Country:US
Practice Address - Phone:586-773-1050
Practice Address - Fax:586-773-2059
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist