Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS027347L | PA |
NPI | 1043328669 |
---|---|
Provider Name | Dr. Richard A Brown |
First Address | Kingston, PA 18704-4509 |
Second Address | Kingston, PA 18704-4509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 23/02/2016 |