Provider Demographics
NPI:1659115772
Name:BROWN, QIANA HALILI (RDH)
Entity type:Individual
Prefix:MS
First Name:QIANA
Middle Name:HALILI
Last Name:BROWN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2414
Mailing Address - Country:US
Mailing Address - Phone:510-691-2177
Mailing Address - Fax:
Practice Address - Street 1:2521 SQUAW CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8003
Practice Address - Country:US
Practice Address - Phone:510-691-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1022124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist