Provider Demographics
NPI:1912195942
Name:BROWN, TIARA (DMD)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TIARA
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:926 S 348TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7021
Mailing Address - Country:US
Mailing Address - Phone:253-924-0717
Mailing Address - Fax:253-925-1439
Practice Address - Street 1:926 S 348TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7021
Practice Address - Country:US
Practice Address - Phone:253-924-0717
Practice Address - Fax:253-925-1439
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4336122300000X
WADENT.DE.605434311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist