Provider Demographics
NPI:1780833954
Name:BROWN, CECILIA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CECILIA
Other - Middle Name:M
Other - Last Name:BROWNBLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4389 CASTLE OAK CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2601
Mailing Address - Country:US
Mailing Address - Phone:954-336-9637
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN182881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery