Provider Demographics
NPI:1649481375
Name:BROWN, MICHAEL A (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 PACIFIC AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4443
Mailing Address - Country:US
Mailing Address - Phone:253-597-4550
Mailing Address - Fax:253-722-1546
Practice Address - Street 1:1708 E 44TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4611
Practice Address - Country:US
Practice Address - Phone:253-572-7002
Practice Address - Fax:253-597-2854
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist