Provider Demographics
NPI:1437671260
Name:BROWN, MARTHA MACY (DMD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:MACY
Last Name:BROWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1225
Mailing Address - Country:US
Mailing Address - Phone:270-338-0606
Mailing Address - Fax:
Practice Address - Street 1:203 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1225
Practice Address - Country:US
Practice Address - Phone:270-338-0606
Practice Address - Fax:270-338-0617
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY110501223G0001X
FLDN22876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice