Provider Demographics
NPI:1083761647
Name:BROWN, SHEILA RENEE' (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:RENEE'
Last Name:BROWN
Suffix:
Gender:F
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:PO BOX 6776
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-6776
Mailing Address - Country:US
Mailing Address - Phone:312-663-1890
Mailing Address - Fax:312-663-1895
Practice Address - Street 1:850 S WABASH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3641
Practice Address - Country:US
Practice Address - Phone:312-663-1890
Practice Address - Fax:312-663-1895
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DNIL19737ALOtherFEP
994848OtherUNITED CONCORDIA
ME2QF679OtherBCBS OF MASS