Provider Demographics
NPI:1265647630
Name:BROWN, IRENE ELEANE (DDS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:ELEANE
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 1:14201 BRADSHAW DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-6504
Mailing Address - Country:US
Mailing Address - Phone:301-879-2081
Mailing Address - Fax:301-879-2081
Practice Address - Street 1:3311 TOLEDO TER
Practice Address - Street 2:SUITE # C203
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4135
Practice Address - Country:US
Practice Address - Phone:301-559-0404
Practice Address - Fax:201-559-2058
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice