Provider Demographics
NPI:1386728889
Name:BROWN, MICHELLE DAWNE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DAWNE
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:PO BOX 1438
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-1438
Mailing Address - Country:US
Mailing Address - Phone:304-682-6104
Mailing Address - Fax:304-682-6157
Practice Address - Street 1:1427 RITCHIE STREET & COOK PARKWAY
Practice Address - Street 2:
Practice Address - City:OCEANA
Practice Address - State:WV
Practice Address - Zip Code:24870
Practice Address - Country:US
Practice Address - Phone:304-682-6104
Practice Address - Fax:304-682-6157
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3115728931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134277000Medicaid