1679873152 NPI number — DR. PHILLIP HAMBLEN BROWN DMD

Table of content: DR. PHILLIP HAMBLEN BROWN DMD (NPI 1679873152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679873152 NPI number — DR. PHILLIP HAMBLEN BROWN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
PHILLIP
Provider Middle Name:
HAMBLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679873152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GREENVILLE TECHNICAL COLLEGE DENTAL PROGRAMS
Provider Second Line Business Mailing Address:
506 S PLEASANTBURG DR
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29607-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-250-8595
Provider Business Mailing Address Fax Number:
864-250-8261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GREENVILLE TECHNICAL COLLEGE DENTAL PROGRAMS
Provider Second Line Business Practice Location Address:
506 S PLEASANTBURG DR
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29607-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-250-8595
Provider Business Practice Location Address Fax Number:
864-250-8261
Provider Enumeration Date:
10/29/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  982 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)