MEDICARE: DR. KEITH W BREWSTER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	14157	TX

General Provider Information

NPI Number	:	1730263765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH W BREWSTER DDS

Provider Business Mailing Address
First Line	:	1717 MAIN ST
Second Line	:	SUITE 2480
City	:	DALLAS
State	:	TX
Zip	:	75202
Country	:	US
Telephone Number	:	214-761-1171
Fax Number	:	214-761-1644

Provider Business Practice Location Address
First Line	:	1717 MAIN ST
Second Line	:	SUITE 2480
City	:	DALLAS
State	:	TX
Zip	:	75202
Country	:	US
Telephone Number	:	214-761-1171
Fax Number	:	214-761-1644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	10/18/2007

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