Provider Demographics
NPI:1174196422
Name:BROWN, MICHELE LEE (DMD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 KNOLL TER
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7563
Mailing Address - Country:US
Mailing Address - Phone:618-402-2778
Mailing Address - Fax:
Practice Address - Street 1:7265 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4401
Practice Address - Country:US
Practice Address - Phone:314-352-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033173122300000X
MO2022018454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty