Provider Demographics
NPI:1649651795
Name:BROWN, LAURA WILMES (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:WILMES
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 1:5921 SE 14TH ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1760
Mailing Address - Country:US
Mailing Address - Phone:515-285-4759
Mailing Address - Fax:
Practice Address - Street 1:5921 SE 14TH ST STE 1500
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1760
Practice Address - Country:US
Practice Address - Phone:515-285-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72111223G0001X
IA092681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice