Provider Demographics
NPI:1457554412
Name:BROWN, DESMOND ANTONIO JR (DDS)
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:ANTONIO
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1121 W. MICHIGAN STREET
Mailing Address - Street 2:DS 307B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5186
Mailing Address - Country:US
Mailing Address - Phone:317-278-3632
Mailing Address - Fax:317-274-2603
Practice Address - Street 1:1001 W. 10TH STREET
Practice Address - Street 2:#3101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2859
Practice Address - Country:US
Practice Address - Phone:317-630-6297
Practice Address - Fax:317-630-2424
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDRP560204E00000X
IN12011641A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery