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General NPI Number Information
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NPI Number | 1710765532
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Entity Type | Individual
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Provider Name | NICOLE LYNN BREWSTER RDH BSDH MSADT
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Gender | Female
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 2430 E HARMON AVE STE 1
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City | LAS VEGAS
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State | NV
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Zip | 89121-5338
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Country | US
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Telephone | 702-796-0095
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Fax | 702-761-4551
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Provider Business Mailing Address
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Address Line | 10620 SOUTHERN HIGHLANDS PKWY # 110-361
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City | LAS VEGAS
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State | NV
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Zip | 89141-4371
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Country | US
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Telephone | 702-205-6273
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Fax |
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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 | 125J00000X
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Taxonomy Name | Dental Therapist
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License Number | DT120
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License Number State | MN
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