Provider Demographics
NPI:1104990910
Name:BROWN, MARTIN JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOHN
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 MINNESOTA ST
Mailing Address - Street 2:SUITE E-720
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1314
Mailing Address - Country:US
Mailing Address - Phone:651-224-1192
Mailing Address - Fax:
Practice Address - Street 1:332 MINNESOTA ST
Practice Address - Street 2:SUITE E-720
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1314
Practice Address - Country:US
Practice Address - Phone:651-224-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND81951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice