Provider Demographics
NPI:1265816177
Name:BROWN, NATHAN EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:EDWARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5202
Mailing Address - Country:US
Mailing Address - Phone:208-819-7895
Mailing Address - Fax:
Practice Address - Street 1:2617 16TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5202
Practice Address - Country:US
Practice Address - Phone:406-452-8180
Practice Address - Fax:406-452-8195
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-226481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics