Provider Demographics
NPI:1396741328
Name:BROWN, MARC D (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:1770 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5524
Mailing Address - Country:US
Mailing Address - Phone:718-901-8110
Mailing Address - Fax:718-901-8121
Practice Address - Street 1:1770 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5524
Practice Address - Country:US
Practice Address - Phone:718-901-8110
Practice Address - Fax:718-901-8121
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY036414-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00849050Medicaid
NY00849050Medicaid