Basic Information
| Provider Information | |||||||||
| NPI: | 1336434620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 E BIJOU ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809098009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195761850 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1901 W 21ST ST N | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672032106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168322838 | ||||||||
| FaxNumber: | 3168329530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 7149 | OK | N | Dental Providers | Dentist | General Practice | 1223G0001X | DD4068 | NM | N | Dental Providers | Dentist | General Practice | 1223G0001X | DEN.00202152 | CO | N | Dental Providers | Dentist | General Practice | 1223G0001X | 61154 | KS | N | Dental Providers | Dentist | General Practice | 122300000X | DEN.00202152 | CO | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 61154 | 01 | KS | KANSAS STATE DENTAL LICENSE | OTHER | 201152510B | 05 | KS | MEDICAID | 83730257 | 05 | CO | MEDICAID |