Provider Demographics
NPI:1922012483
Name:BREWER, HAMILTON CLARK (DDS)
Entity Type:Individual
Prefix:MR
First Name:HAMILTON
Middle Name:CLARK
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 1:212 EAST WINSLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401
Mailing Address - Country:US
Mailing Address - Phone:812-337-8888
Mailing Address - Fax:812-337-1931
Practice Address - Street 1:212 EAST WINSLOW ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401
Practice Address - Country:US
Practice Address - Phone:812-337-8888
Practice Address - Fax:812-337-1931
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100185060AMedicaid