=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962096818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREWSTER DENTAL ARTS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2021
-----------------------------------------------------
Last Update Date | 02/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2542 MAIN STREET
-----------------------------------------------------
City | BREWSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-896-5732
-----------------------------------------------------
Fax | 508-896-3134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1108
-----------------------------------------------------
City | BREWSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02631-7108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-896-5732
-----------------------------------------------------
Fax | 508-896-3134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. DAVID TODD QUINTON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 508-896-5732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------