Provider Demographics
NPI:1114120342
Name:BROWN, MICHELLE PENLEY (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PENLEY
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 1:1401 AVERSBORO ROAD
Mailing Address - Street 2:STE 202
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:919-779-2818
Mailing Address - Fax:919-779-5805
Practice Address - Street 1:1401 AVERSBORO ROAD
Practice Address - Street 2:STE 202
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-779-2818
Practice Address - Fax:919-779-5805
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist