Healthcare Provider Details

I. General information

NPI: 1649481375
Provider Name (Legal Business Name): MICHAEL A. BROWN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E 44TH ST
TACOMA WA
98404-4611
US

IV. Provider business mailing address

1019 PACIFIC AVE STE 300
TACOMA WA
98402-4443
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-7002
  • Fax: 253-597-2854
Mailing address:
  • Phone: 253-597-4550
  • Fax: 253-722-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00008530
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: