Provider Demographics
NPI:1316231889
Name:BROWN, MELISSA L (DMD, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2545
Mailing Address - Country:US
Mailing Address - Phone:607-937-5335
Mailing Address - Fax:607-962-8580
Practice Address - Street 1:149 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2545
Practice Address - Country:US
Practice Address - Phone:607-937-5335
Practice Address - Fax:607-962-8580
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055371-11223X0400X
PADS0375231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics