Provider Demographics
NPI:1831271212
Name:BROWN, AMY EVELYN (DMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:EVELYN
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9120 HURSTBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1627
Mailing Address - Country:US
Mailing Address - Phone:502-671-5087
Mailing Address - Fax:
Practice Address - Street 1:9120 HURSTBOURNE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1627
Practice Address - Country:US
Practice Address - Phone:502-671-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY80041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice