Provider Demographics
NPI:1336267665
Name:BREWTON, DAVID M (DDS,PC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BREWTON
Suffix:
Gender:F
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E CEDAR AVE
Mailing Address - Street 2:C-2
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1600
Mailing Address - Country:US
Mailing Address - Phone:928-774-7373
Mailing Address - Fax:
Practice Address - Street 1:1515 E CEDAR AVE
Practice Address - Street 2:C-2
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1600
Practice Address - Country:US
Practice Address - Phone:928-774-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ30301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice