Provider Demographics
NPI:1922118710
Name:BREWBAKER, MARLENE DENISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:DENISE
Last Name:BREWBAKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895
Mailing Address - Country:US
Mailing Address - Phone:517-655-2129
Mailing Address - Fax:517-655-2120
Practice Address - Street 1:425 W GRAND RIVER
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895
Practice Address - Country:US
Practice Address - Phone:517-655-2129
Practice Address - Fax:517-655-2120
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI170301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice