Provider Demographics
NPI:1164529277
Name:BROWN-DOONQUAH, THERESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:BROWN-DOONQUAH
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 340
Mailing Address - Street 2:KEWA PUEBLO HEALTH CORPORATION
Mailing Address - City:SANTO DOMINGO PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87052-0340
Mailing Address - Country:US
Mailing Address - Phone:505-465-3078
Mailing Address - Fax:505-465-1153
Practice Address - Street 1:85 WEST HIGHWAY 22
Practice Address - Street 2:KEWA PUEBLO HEALTH CORPORATION
Practice Address - City:SANTO DOMINGO PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87052-0340
Practice Address - Country:US
Practice Address - Phone:505-465-3078
Practice Address - Fax:505-465-1153
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist