Provider Demographics
NPI:1508906710
Name:BROWN, ROBERTA KATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:KATHERINE
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 1:4369 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53219-4715
Mailing Address - Country:US
Mailing Address - Phone:414-321-3444
Mailing Address - Fax:414-546-2805
Practice Address - Street 1:4369 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53219-4715
Practice Address - Country:US
Practice Address - Phone:414-321-3444
Practice Address - Fax:414-546-2805
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137GWI1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics