MEDICARE: DR. KAMILLE LYNETTE BROWN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019029056	IL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	390200000X	Student in an Organized Health Care Education/Training Program		OH
4	122300000X	Dentist	2901022420	MI

General Provider Information

NPI Number	:	1114287182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMILLE LYNETTE BROWN D.D.S.

Provider Business Mailing Address
First Line	:	404 FISHER RD
Second Line	:
City	:	GROSSE POINTE FARMS
State	:	MI
Zip	:	48230-1281
Country	:	US
Telephone Number	:	248-931-3931
Fax Number	:

Provider Business Practice Location Address
First Line	:	16800 W 12 MILE RD STE 101
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-6335
Country	:	US
Telephone Number	:	248-423-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	06/25/2024

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