Provider Demographics
NPI:1356534374
Name:BREWSTER,BREWSTER,FREDERICK, DDS, INS.
Entity type:Organization
Organization Name:BREWSTER,BREWSTER,FREDERICK, DDS, INS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-947-7737
Mailing Address - Street 1:937 E PALMDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4711
Mailing Address - Country:US
Mailing Address - Phone:661-947-7737
Mailing Address - Fax:661-947-0522
Practice Address - Street 1:937 E PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4711
Practice Address - Country:US
Practice Address - Phone:661-947-7737
Practice Address - Fax:661-947-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty