Provider Demographics
NPI:1619719572
Name:BREWER, TANNA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:TANNA
Middle Name:ANN
Last Name:BREWER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:TANNA
Other - Middle Name:ANN
Other - Last Name:HEDDLESTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:368 VANDEVEER RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-6889
Mailing Address - Country:US
Mailing Address - Phone:918-302-8326
Mailing Address - Fax:
Practice Address - Street 1:3101 ELKS ROAD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-426-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist