MEDICARE: BREWER DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1295341287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREWER DENTAL PLLC

Provider Business Mailing Address
First Line	:	2415 MARTIN LUTHER KING JR DR
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-1774
Country	:	US
Telephone Number	:	409-886-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 MARTIN LUTHER KING JR DR
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-1774
Country	:	US
Telephone Number	:	409-886-2323
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES TODD BREWER
Credential	:	DDS
Telephone Number	:	940-231-8306

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	09/16/2020

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