Provider Demographics
NPI:1649962085
Name:BROWN, CHANEY MYCRAE (DMD)
Entity type:Individual
Prefix:DR
First Name:CHANEY
Middle Name:MYCRAE
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 1:2101 SPEED AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1353
Mailing Address - Country:US
Mailing Address - Phone:270-562-2088
Mailing Address - Fax:
Practice Address - Street 1:2101 SPEED AVE APT 13
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1353
Practice Address - Country:US
Practice Address - Phone:270-562-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014082A122300000X
390200000X
KY10946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program