Provider Demographics
NPI:1346370004
Name:BREWER, DAVID MATSON (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MATSON
Last Name:BREWER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 INVERNESS CENTER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-991-8850
Mailing Address - Fax:205-991-8656
Practice Address - Street 1:254 INVERNESS CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-991-8850
Practice Address - Fax:205-991-8656
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL82894Medicare UPIN