Provider Demographics
NPI:1801214713
Name:BROWN, INDIA LEOLA (DDS)
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:LEOLA
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 1:910 MADISON AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3403
Mailing Address - Country:US
Mailing Address - Phone:901-232-2438
Mailing Address - Fax:901-232-2438
Practice Address - Street 1:910 MADISON AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3403
Practice Address - Country:US
Practice Address - Phone:901-232-2438
Practice Address - Fax:901-232-2438
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist