Active NPI
Kelly Ann Brewer, D.D.S.
- Dentist
- Davis, CA
National Provider Identifier
1154655629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 58852
- Practice address
- 1627 Oak Ave
Suite B
Davis, CA 95616-1072 - Phone
- (530) 758-3020
- Fax
- (530) 758-3026
- NPI assigned
- Sep 30, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 58852 | CA | Primary |
Addresses
Primary practice location
1627 Oak Ave
Suite B
Davis, CA 95616-1072
Mailing address
1627 Oak Ave
Suite B
Davis, CA 95616-1072
Phone (530) 758-3020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58852 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254268800000",
"number": "1154655629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1627 OAK AVE",
"address_2": "SUITE B",
"city": "DAVIS",
"state": "CA",
"postal_code": "956161072",
"telephone_number": "530-758-3020",
"fax_number": "530-758-3026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1627 OAK AVE",
"address_2": "SUITE B",
"city": "DAVIS",
"state": "CA",
"postal_code": "956161072",
"telephone_number": "530-758-3020",
"fax_number": "530-758-3026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREWER",
"first_name": "KELLY",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-30",
"last_updated": "2009-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "58852",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.