Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 3358 | SC |
NPI | 1033310685 |
---|---|
Provider Name | Dr. Kerry White Brown |
First Address | Columbia, SC 29223-7649 |
Second Address | Columbia, SC 29223-7649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |