Provider Demographics
NPI:1447484928
Name:BROWN, STANLEY ERNEST (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ERNEST
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2042
Mailing Address - Country:US
Mailing Address - Phone:715-623-5331
Mailing Address - Fax:715-627-1852
Practice Address - Street 1:705 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2042
Practice Address - Country:US
Practice Address - Phone:715-623-5331
Practice Address - Fax:715-627-1852
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5020-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice