Provider Demographics
NPI:1811083306
Name:BROWN, CARROLL DAN JR (DDS)
Entity type:Individual
Prefix:
First Name:CARROLL
Middle Name:DAN
Last Name:BROWN
Suffix:JR
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 1:3637 BROADWAY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043
Mailing Address - Country:US
Mailing Address - Phone:972-271-0524
Mailing Address - Fax:972-278-9557
Practice Address - Street 1:3637 BROADWAY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043
Practice Address - Country:US
Practice Address - Phone:972-271-0524
Practice Address - Fax:972-278-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice