MEDICARE: DR. CASEY B BREWER DMD

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	122300000X	Dentist	2901600877	MI
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	13408631-9921	UT

General Provider Information

NPI Number	:	1306426721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY B BREWER DMD

Provider Business Mailing Address
First Line	:	1792 W 1700 S STE 101
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-9650
Country	:	US
Telephone Number	:	801-614-0099
Fax Number	:

Provider Business Practice Location Address
First Line	:	1792 W 1700 S STE 101
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-9650
Country	:	US
Telephone Number	:	801-614-0099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2021
Last Update Date	:	11/16/2023

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Directions to “ DR. CASEY B BREWER DMD” Practice Location

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