Provider Demographics
NPI:1942470448
Name:BROWN, CAROLYN W (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:W
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CLEMSON RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9538
Mailing Address - Country:US
Mailing Address - Phone:803-736-9392
Mailing Address - Fax:
Practice Address - Street 1:2000 CLEMSON RD
Practice Address - Street 2:SUITE 15
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9538
Practice Address - Country:US
Practice Address - Phone:803-736-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3357122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ33571Medicaid