MEDICARE: DR. KIARA DANIELLE 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	17375	MD
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2020014141	MO
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	2020014141	MO
4	390200000X	Student in an Organized Health Care Education/Training Program
5	122300000X	Dentist	019030447	IL

General Provider Information

NPI Number	:	1770962953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIARA DANIELLE BROWN DDS

Provider Business Mailing Address
First Line	:	6798 OAK HALL LN STE A1
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5167
Country	:	US
Telephone Number	:	410-290-7757
Fax Number	:	410-290-8182

Provider Business Practice Location Address
First Line	:	405 FREDERICK RD STE 9
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-4607
Country	:	US
Telephone Number	:	410-744-4484
Fax Number	:	410-455-6175

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

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	08/09/2022

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