MEDICARE: IRENE ELEANE BROWN DDS

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	1223G0001X	General Practice Dentistry	10084	MD

General Provider Information

NPI Number	:	1265647630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE ELEANE BROWN DDS

Provider Business Mailing Address
First Line	:	14201 BRADSHAW DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-6504
Country	:	US
Telephone Number	:	301-879-2081
Fax Number	:	301-879-2081

Provider Business Practice Location Address
First Line	:	3311 TOLEDO TER
Second Line	:	SUITE # C203
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-4135
Country	:	US
Telephone Number	:	301-559-0404
Fax Number	:	201-559-2058

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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