Active NPI
Charles Robert Brown, D.M.D.
- Pediatric Dentistry
- Daytona Beach, FL
National Provider Identifier
1073613600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 5643
- Practice address
- 912 S Ridgewood Ave
Suite B
Daytona Beach, FL 32114-5349 - Phone
- (386) 258-6132
- Fax
- (386) 239-0730
- NPI assigned
- Sep 24, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 5643 | FL | Primary |
Addresses
Primary practice location
912 S Ridgewood Ave
Suite B
Daytona Beach, FL 32114-5349
Mailing address
6211 Santa Monica Dr
Port Orange, FL 32127-5964
Phone (386) 761-5546
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5643 | Other | FL | DENTAL LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5643 | FL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1073613600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6211 SANTA MONICA DR",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321275964",
"telephone_number": "386-761-5546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 S RIDGEWOOD AVE",
"address_2": "SUITE B",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321145349",
"telephone_number": "386-258-6132",
"fax_number": "386-239-0730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "CHARLES",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "FL",
"license": "5643",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE NUMBER",
"identifier": "5643",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.