Provider Demographics
NPI:1073808457
Name:JEFFREY L. BREWER DDS PC
Entity Type:Organization
Organization Name:JEFFREY L. BREWER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-332-3431
Mailing Address - Street 1:10298 WALDEN ST
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-5152
Mailing Address - Country:US
Mailing Address - Phone:423-332-3431
Mailing Address - Fax:423-332-5848
Practice Address - Street 1:10298 WALDEN ST
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-5152
Practice Address - Country:US
Practice Address - Phone:423-332-3431
Practice Address - Fax:423-332-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty