Provider Demographics
NPI:1154439271
Name:BREWER, JAMES LARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LARRY
Last Name:BREWER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 N GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854
Mailing Address - Country:US
Mailing Address - Phone:865-354-3910
Mailing Address - Fax:865-354-3920
Practice Address - Street 1:1647 E STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4609
Practice Address - Country:US
Practice Address - Phone:423-245-2202
Practice Address - Fax:423-245-0834
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS6959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist