Provider Demographics
NPI:1750519765
Name:BROWN, MARK J (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
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 1:13101 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8950
Mailing Address - Country:US
Mailing Address - Phone:530-559-7211
Mailing Address - Fax:
Practice Address - Street 1:707 ZION ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2932
Practice Address - Country:US
Practice Address - Phone:530-265-4206
Practice Address - Fax:530-265-9033
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist