Provider Demographics
NPI:1770650384
Name:BROWN, MEHRAVAR E (DDS)
Entity Type:Individual
Prefix:
First Name:MEHRAVAR
Middle Name:E
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 1634
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93044-1634
Mailing Address - Country:US
Mailing Address - Phone:909-631-1383
Mailing Address - Fax:
Practice Address - Street 1:200 S WELLS RD STE 225
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1382
Practice Address - Country:US
Practice Address - Phone:805-659-0560
Practice Address - Fax:805-659-9275
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist