Provider Demographics
NPI:1306187380
Name:BROWN, LAURIE M (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2321
Mailing Address - Country:US
Mailing Address - Phone:413-525-6626
Mailing Address - Fax:413-525-1133
Practice Address - Street 1:52 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2321
Practice Address - Country:US
Practice Address - Phone:413-525-6626
Practice Address - Fax:413-525-1133
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist