Healthcare Provider Details

I. General information

NPI: 1720654833
Provider Name (Legal Business Name): JESSICA RENEE BREWER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2021
Last Update Date: 05/29/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 113TH ST
SEMINOLE FL
33772-2800
US

IV. Provider business mailing address

9200 113TH ST
SEMINOLE FL
33772-2800
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-5050
  • Fax: 727-394-6098
Mailing address:
  • Phone: 727-893-5050
  • Fax: 727-394-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN25839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: