Active NPI
Russell Scott Brewster, D.D.S.
- General Practice Dentistry
- Nacogdoches, TX
National Provider Identifier
1295894376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14158
- Practice address
- 1211 Park Street
Nacogdoches, TX 75961-1211 - Phone
- (936) 569-3958
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14158 | TX | Primary |
Addresses
Primary practice location
1211 Park Street
Nacogdoches, TX 75961-1211
Mailing address
PO Box 631250
Nacogdoches, TX 75963-1250
Phone (936) 569-3958
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 |
|---|---|---|---|
| 14158 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468800000000",
"number": "1295894376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 631250",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759631250",
"telephone_number": "936-569-3958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 PARK STREET",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759611211",
"telephone_number": "936-569-3958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREWSTER",
"first_name": "RUSSELL",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2016-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "14158",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nacogdoches, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.