Provider Demographics
NPI:1558563247
Name:BREWER, GARY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
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 1:646 SWIFT ROAD
Mailing Address - Street 2:DENTAC
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:646 SWIFT RD
Practice Address - Street 2:DENTAC
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1905
Practice Address - Country:US
Practice Address - Phone:845-938-3121
Practice Address - Fax:845-938-4302
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN3019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist