Provider Demographics
NPI:1639586571
Name:BROWN, MARY MARGARET (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
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:PO BOX 751
Mailing Address - Street 2:110 E ARAPAHOE ST.
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443
Mailing Address - Country:US
Mailing Address - Phone:307-864-9411
Mailing Address - Fax:
Practice Address - Street 1:110 E ARAPAHOE
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443
Practice Address - Country:US
Practice Address - Phone:307-864-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist