Provider Demographics
NPI:1336385020
Name:BROWN, NATHAN RIAS (MD, DMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:RIAS
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 7TH ST
Mailing Address - Street 2:NORTHLAKE ORAL AND FACIAL SURGERY LLC
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-643-1010
Mailing Address - Fax:
Practice Address - Street 1:1271 7TH ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-643-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.28043204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051117632OtherBCBS
AL051118675OtherBCBS
AL051117634OtherBCBS
AL129134Medicaid
AL129133Medicaid
AL129135Medicaid
AL129136Medicaid
ALZ21003OtherVIVA
MS01586093Medicaid
AL051117635OtherBCBS
AL051117856OtherBCBS
AL129132Medicaid
AL102I194687Medicare PIN