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General NPI Number Information
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NPI Number | 1457554412
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Entity Type | Individual
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Provider Name | DESMON ANTONIO BROWN JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 1001 W. 10TH STREET #3101
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2859
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Country | US
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Telephone | 317-630-6297
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Fax | 317-630-2424
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Provider Business Mailing Address
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Address Line | 1168 WESTVALIE DRIVE
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City | CARMEL
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State | IN
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Zip | 46032
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Country | US
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Telephone | 904-537-5764
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Fax | 317-274-2603
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DRP560
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 12011641A
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License Number State | IN
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