Provider Demographics
NPI:1245294875
Name:BROWN, VICTOR DOUGLAS (DMD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:DOUGLAS
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 SR 49 EAST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915
Mailing Address - Country:US
Mailing Address - Phone:814-274-7194
Mailing Address - Fax:814-274-7786
Practice Address - Street 1:6 NILES HILL ROAD
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915
Practice Address - Country:US
Practice Address - Phone:814-274-1111
Practice Address - Fax:814-274-7786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022313L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist