Provider Demographics
NPI:1326262494
Name:BROWN, TANYA (DMD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
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 1:601 CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6950
Mailing Address - Country:US
Mailing Address - Phone:757-547-2068
Mailing Address - Fax:
Practice Address - Street 1:129 HANBURY RD W
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4283
Practice Address - Country:US
Practice Address - Phone:757-546-5262
Practice Address - Fax:757-546-5265
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA74557OtherUCCI PROVIDER NUMBER