Provider Demographics
NPI:1518066356
Name:MICHELLE D. BROWN DDS, & MICHAEL B. MOORE DDS, INC.
Entity Type:Organization
Organization Name:MICHELLE D. BROWN DDS, & MICHAEL B. MOORE DDS, INC.
Other - Org Name:OCEANA DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DAWNE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-682-6104
Mailing Address - Street 1:PO BOX 1438
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-1438
Mailing Address - Country:US
Mailing Address - Phone:304-682-6104
Mailing Address - Fax:
Practice Address - Street 1:1427 RITCHIE STREET & COOK PARKWAY
Practice Address - Street 2:
Practice Address - City:OCEANA
Practice Address - State:WV
Practice Address - Zip Code:24870-1438
Practice Address - Country:US
Practice Address - Phone:304-682-6104
Practice Address - Fax:304-682-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV-0021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004900Medicaid