Provider Demographics
NPI:1023244019
Name:BREWSTER, BETH LEA (DDS)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:LEA
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:LEA
Other - Last Name:BLANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11719 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3320
Mailing Address - Country:US
Mailing Address - Phone:410-526-6272
Mailing Address - Fax:
Practice Address - Street 1:11719 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3320
Practice Address - Country:US
Practice Address - Phone:410-526-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice