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General NPI Number Information
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NPI Number | 1154655629
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Entity Type | Individual
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Provider Name | KELLY ANN BREWER D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | 1627 OAK AVE SUITE B
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City | DAVIS
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State | CA
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Zip | 95616-1072
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Country | US
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Telephone | 530-758-3020
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Fax | 530-758-3026
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Provider Business Mailing Address
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Address Line | 1627 OAK AVE SUITE B
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City | DAVIS
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State | CA
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Zip | 95616-1072
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Country | US
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Telephone | 530-758-3020
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Fax | 530-758-3026
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 58852
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License Number State | CA
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