Provider Demographics
NPI:1790160802
Name:BROWN, LEONARD (DDS)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:BROWN
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 1:3500 CLEMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1313
Mailing Address - Country:US
Mailing Address - Phone:864-401-8448
Mailing Address - Fax:864-401-8452
Practice Address - Street 1:3500 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1313
Practice Address - Country:US
Practice Address - Phone:864-401-8448
Practice Address - Fax:864-401-8452
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist