Provider Demographics
NPI:1700083292
Name:BROWN, SHANAN MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANAN
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHANAN
Other - Middle Name:MARIE
Other - Last Name:MOSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6200 SARATOGA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3421
Mailing Address - Country:US
Mailing Address - Phone:210-859-6261
Mailing Address - Fax:
Practice Address - Street 1:6200 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3421
Practice Address - Country:US
Practice Address - Phone:210-859-6261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700083292Medicaid