Provider Demographics
NPI:1508035874
Name:BROWN, RICHARD SAMUEL IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SAMUEL
Last Name:BROWN
Suffix:IV
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 1:14 CONCORD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2356
Mailing Address - Country:US
Mailing Address - Phone:617-864-2577
Mailing Address - Fax:
Practice Address - Street 1:14 CONCORD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2356
Practice Address - Country:US
Practice Address - Phone:617-864-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000X03835OtherBCBSMA