Provider Demographics
NPI:1700972064
Name:BROWN, THEODOR HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODOR
Middle Name:HOWARD
Last Name:BROWN
Suffix:
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 1:18 ASHFORD AVE
Mailing Address - Street 2:MEZZ
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522
Mailing Address - Country:US
Mailing Address - Phone:914-693-6656
Mailing Address - Fax:914-693-8247
Practice Address - Street 1:18 ASHFORD AVE
Practice Address - Street 2:MEZZ
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522
Practice Address - Country:US
Practice Address - Phone:914-693-6656
Practice Address - Fax:914-693-8247
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist