Provider Demographics
NPI:1477170462
Name:BROWN-MINOR, KATELYN JANAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:JANAE
Last Name:BROWN-MINOR
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 1:1120 BOYER ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-2105
Mailing Address - Country:US
Mailing Address - Phone:937-423-9057
Mailing Address - Fax:
Practice Address - Street 1:1717 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1612
Practice Address - Country:US
Practice Address - Phone:765-965-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013417A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice