Dale Richard Brown, DDS
Individual provider Active NPI Dentist · Carver, MN
NPI 1104495225 · NPPES record last updated Jun 22, 2021
Key facts
- NPI
- 1104495225
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D14599 (MN)
- Practice address
- 4725 Dahlgren Rd
Carver, MN 55315-2201 - Phone
- (952) 960-9060
- NPI assigned
- Jun 22, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14599 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carver Dental PA | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | D14599 | MN | Yes |
Addresses
Primary practice location
4725 Dahlgren Rd
Carver, MN 55315-2201
Mailing address
21235 Flowering Dogwood Cir
Porter, TX 77365-6889
Phone (832) 445-4513
Other providers in Carver, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.