Provider Demographics
NPI:1972018174
Name:CARSON V BROWN II DDS LLC
Entity Type:Organization
Organization Name:CARSON V BROWN II DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARSON
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-769-9130
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:MC ELHATTAN
Mailing Address - State:PA
Mailing Address - Zip Code:17748-0450
Mailing Address - Country:US
Mailing Address - Phone:570-769-9130
Mailing Address - Fax:570-769-9133
Practice Address - Street 1:550 MCELHATTAN DR
Practice Address - Street 2:
Practice Address - City:MCELHATTAN
Practice Address - State:PA
Practice Address - Zip Code:17748-0450
Practice Address - Country:US
Practice Address - Phone:570-769-9130
Practice Address - Fax:570-769-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026291-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18-54448914OtherNPI ENTITY 1