Provider Demographics
NPI:1427162601
Name:BROWN, MICHAEL KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENNETH
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 1:31 OFALLON SQUARE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3034
Mailing Address - Country:US
Mailing Address - Phone:636-240-1750
Mailing Address - Fax:636-240-1751
Practice Address - Street 1:31 OFALLON SQUARE
Practice Address - Street 2:
Practice Address - City:OFALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3034
Practice Address - Country:US
Practice Address - Phone:636-240-1750
Practice Address - Fax:636-240-1751
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist