Provider Demographics
NPI:1619403730
Name:BROWN, MATTHEW JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 NATORP BLVD
Mailing Address - Street 2:APT 400
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2542
Mailing Address - Country:US
Mailing Address - Phone:614-507-1260
Mailing Address - Fax:
Practice Address - Street 1:5685 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2226
Practice Address - Country:US
Practice Address - Phone:937-435-5163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist