Provider Demographics
NPI:1093599219
Name:BREWER, QUINESHA SHAMIRA (RDH)
Entity Type:Individual
Prefix:
First Name:QUINESHA
Middle Name:SHAMIRA
Last Name:BREWER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 BILLINGS CT SE APT 2B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7373
Mailing Address - Country:US
Mailing Address - Phone:231-740-9066
Mailing Address - Fax:
Practice Address - Street 1:4700 KALAMAZOO AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-4628
Practice Address - Country:US
Practice Address - Phone:616-281-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902016046124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist