Provider Demographics
NPI:1740202928
Name:BROWN, CARMIE LOU ANN (DDS)
Entity Type:Individual
Prefix:
First Name:CARMIE
Middle Name:LOU ANN
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 1:12801 EDGEMERE BLVD # B
Mailing Address - Street 2:STE 112
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-9500
Mailing Address - Country:US
Mailing Address - Phone:915-493-6310
Mailing Address - Fax:
Practice Address - Street 1:12801 EDGEMERE BLVD # B
Practice Address - Street 2:STE 112
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-9500
Practice Address - Country:US
Practice Address - Phone:915-493-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD27501223G0001X
TX250001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211397905Medicaid