Provider Demographics
NPI:1841342003
Name:BROWN, CHARLES DAVID
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 SAND CANYON AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3716
Mailing Address - Country:US
Mailing Address - Phone:949-833-8020
Mailing Address - Fax:949-833-9356
Practice Address - Street 1:16100 SAND CANYON AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3716
Practice Address - Country:US
Practice Address - Phone:949-833-8020
Practice Address - Fax:949-833-9356
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist