Mitchell York Brown, DDS
Individual provider Active NPI General Practice Dentistry · Fort Eisenhower, GA
NPI 1104666221 · NPPES record last updated Dec 19, 2024
Key facts
- NPI
- 1104666221
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 13994064-9923 (UT)
- Practice address
- Building 25501 Brainard Ave
Fort Eisenhower, GA 30905 - Phone
- (706) 787-7050
- NPI assigned
- May 28, 2024
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 13994064-9923 | UT | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13994064-9923 | UT | Yes |
Addresses
Primary practice location
Building 25501 Brainard Ave
Fort Eisenhower, GA 30905
Mailing address
384 S Carmel Ridge Cir
Cedar City, UT 84720-1995
Phone (435) 592-0358
Other providers in Fort Eisenhower, GA
- Michael Donald Beres
- Spencer Blankenship
- David Edward Bonnin
- Benjamin Brainerd
- Kerrianne Bresnan
- Leslee Nichole Browning
- Lauren Geeter Bursey
- John Price Caldwell Sr.
- Christina Janelle Campo Ford
- Jane Emily Carnett
All providers in Fort Eisenhower, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2024. 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.