Garth I Brewer, DDS
Individual provider Active NPI General Practice Dentistry · Ottawa, IL
NPI 1003843798 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003843798
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019890 (IL)
- Practice address
- 417 W Madison St
Suite 101B
Ottawa, IL 61350-2836 - Phone
- (815) 433-1258
- Fax
- (815) 433-9025
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019890 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019890 | IL | Yes |
Addresses
Primary practice location
417 W Madison St
Suite 101B
Ottawa, IL 61350-2836
Mailing address
417 W Madison St
Suite 101B
Ottawa, IL 61350-2836
Phone (815) 433-1258
Other providers in Ottawa, IL
- Peter Borek
- Barry Bowers Jr.
- Donnette Anitra Brass
- Natalie Brauweiler
- Christopher Brewer
- Brightside Recovery LTD
- Angelica Briones
- Misael S Briones
- Brittany M Jones DPM LLC
- Yulandist Jeannie Brown
All providers in Ottawa, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.