Provider Demographics
NPI:1194138503
Name:BROWN, CYNTHIA E (DDS)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:E
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 S RIVERSIDE DR APT 1404
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-1742
Mailing Address - Country:US
Mailing Address - Phone:901-834-4482
Mailing Address - Fax:
Practice Address - Street 1:50 GOODMAN RD W STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9403
Practice Address - Country:US
Practice Address - Phone:662-470-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4123-201223G0001X
TN00000000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice