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General NPI Number Information
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NPI Number | 1366504078
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Entity Type | Individual
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Provider Name | MICHELLE BRENDA BROWN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 567 W 14TH ST
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411
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Country | US
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Telephone | 708-283-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 901 VERNE LN
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City | FLOSSMOOR
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State | IL
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Zip | 60422-1128
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Country | US
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Telephone | 773-835-0427
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12011745A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12011745A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019023014
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License Number State | IL
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