Individual provider Active NPI

Cynthia E Brown, D.D.S.

  • Dentist
  • Southaven, MS
National Provider Identifier
1194138503
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
00000000 Issued in TN
Practice address
50 Goodman Rd W Ste 2
Southaven, MS 38671-9403
Phone
(662) 470-2284
NPI assigned
Jun 4, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4123-20 MS
Dentist 122300000X 00000000 TN Primary

Addresses

Primary practice location

50 Goodman Rd W Ste 2
Southaven, MS 38671-9403

Mailing address

717 S Riverside Dr Apt 1404
Memphis, TN 38103-1742
Phone (901) 834-4482

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160916001763 TN Order and Referring Only - DentistPractitioner - Dentist 6204123318

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4123-20MSMDGeneral Practice Dentistry
00000000TNMDUrology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1194138503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 S RIVERSIDE DR APT 1404",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381031742",
            "telephone_number": "901-834-4482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 GOODMAN RD W STE 2",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719403",
            "telephone_number": "662-470-2284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "CYNTHIA",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-04",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4123-20",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "00000000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.