Provider Demographics
NPI:1538516422
Name:BROWN, TANEISHA LIVINGSTON (DDS)
Entity Type:Individual
Prefix:
First Name:TANEISHA
Middle Name:LIVINGSTON
Last Name:BROWN
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 1:125 PUTTERS CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9817
Mailing Address - Country:US
Mailing Address - Phone:919-951-4935
Mailing Address - Fax:
Practice Address - Street 1:10940 RAVEN RIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6611
Practice Address - Country:US
Practice Address - Phone:919-845-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103981223X0400X
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics