Provider Demographics
NPI:1588669089
Name:BROWN, DENISE ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ANN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4000 SMITHTOWN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6559
Mailing Address - Country:US
Mailing Address - Phone:770-932-4404
Mailing Address - Fax:
Practice Address - Street 1:4000 SMITHTOWN RD
Practice Address - Street 2:STE 150
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6560
Practice Address - Country:US
Practice Address - Phone:770-932-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA011678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA011678OtherSTATE LISCENCE