Healthcare Provider Details

I. General information

NPI: 1275612087
Provider Name (Legal Business Name): TAMARA BROWN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S MAIN STREET 1ST FLR
PHILLIPSBURG NJ
08865
US

IV. Provider business mailing address

320 SOUTH MAIN STREET 2ND FLR CORPORATE OFFICE
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-9800
  • Fax: 908-454-1351
Mailing address:
  • Phone: 908-387-6120
  • Fax: 908-387-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDI021464
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: