Provider Demographics
NPI:1295894376
Name:BREWSTER, RUSSELL SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:SCOTT
Last Name:BREWSTER
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:PO BOX 631250
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-1250
Mailing Address - Country:US
Mailing Address - Phone:936-569-3958
Mailing Address - Fax:
Practice Address - Street 1:1211 PARK STREET
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-1211
Practice Address - Country:US
Practice Address - Phone:936-569-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice