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General NPI Number Information
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NPI Number | 1710051362
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Entity Type | Individual
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Provider Name | AMANDA RENEE' BREWER D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1213 COFFEE RD SUITE H
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City | MODESTO
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State | CA
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Zip | 95355-4229
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Country | US
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Telephone | 209-578-0707
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Fax | 209-578-1016
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Provider Business Mailing Address
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Address Line | 1213 COFFEE RD SUITE H
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City | MODESTO
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State | CA
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Zip | 95355-4229
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Country | US
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Telephone | 209-578-0707
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Fax | 209-578-1016
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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 | 52714
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License Number State | CA
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