Provider Demographics
NPI:1912913864
Name:BROWN, STEPHEN D (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
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 1:7780 MICHIGAN RD
Mailing Address - Street 2:B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2374
Mailing Address - Country:US
Mailing Address - Phone:317-848-9531
Mailing Address - Fax:
Practice Address - Street 1:7780 MICHIGAN RD
Practice Address - Street 2:B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2374
Practice Address - Country:US
Practice Address - Phone:317-848-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007584A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice