Provider Demographics
NPI:1568515062
Name:BREWSTER, ROY DAVID (DDS, CST)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:DAVID
Last Name:BREWSTER
Suffix:
Gender:M
Credentials:DDS, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:8 CLOVER LANE, STE. 2
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598-0239
Mailing Address - Country:US
Mailing Address - Phone:603-837-9342
Mailing Address - Fax:603-837-2890
Practice Address - Street 1:8 CLOVER LANE
Practice Address - Street 2:STE. 2
Practice Address - City:WHITEFIELD
Practice Address - State:NH
Practice Address - Zip Code:03598-0239
Practice Address - Country:US
Practice Address - Phone:603-837-9342
Practice Address - Fax:603-837-2890
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80001552Medicaid