Provider Demographics
NPI:1497110639
Name:BROWN, TAMARA LYNN APRIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNN APRIL
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LYNN APRIL
Other - Last Name:FAYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4552 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-4733
Mailing Address - Country:US
Mailing Address - Phone:612-825-1697
Mailing Address - Fax:
Practice Address - Street 1:4552 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-4733
Practice Address - Country:US
Practice Address - Phone:612-825-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist