Provider Demographics
NPI:1750445078
Name:BREWER, HAROLD EUGENE (DDS)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:EUGENE
Last Name:BREWER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:212 E WINSLOW RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8657
Mailing Address - Country:US
Mailing Address - Phone:812-336-2846
Mailing Address - Fax:812-331-1931
Practice Address - Street 1:212 E WINSLOW RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8657
Practice Address - Country:US
Practice Address - Phone:812-336-2846
Practice Address - Fax:812-331-1931
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007324A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist