Provider Demographics
NPI:1316625346
Name:BREWER, MATTHEW RANDEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RANDEL
Last Name:BREWER
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 1:831 S GAY ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5944
Mailing Address - Country:US
Mailing Address - Phone:804-698-0508
Mailing Address - Fax:
Practice Address - Street 1:1610 2ND AVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5618
Practice Address - Country:US
Practice Address - Phone:334-745-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007221-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist