Provider Demographics
NPI:1396903134
Name:BREWER, KEVIN ANDREW (DDS MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:BREWER
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7677 CENTER AVE STE 409
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3098
Mailing Address - Country:US
Mailing Address - Phone:714-897-3543
Mailing Address - Fax:714-897-0505
Practice Address - Street 1:7677 CENTER AVE STE 409
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3098
Practice Address - Country:US
Practice Address - Phone:714-897-3543
Practice Address - Fax:714-897-0505
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1048711223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program