Provider Demographics
NPI:1013134253
Name:BROWN, SAMUEL WELDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WELDON
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 1:2553 CHAIN BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181
Mailing Address - Country:US
Mailing Address - Phone:703-938-0212
Mailing Address - Fax:
Practice Address - Street 1:2553 CHAIN BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181
Practice Address - Country:US
Practice Address - Phone:703-938-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010038151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice