Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS0000006943 | TN |
NPI | 1700144425 |
---|---|
Provider Name | Dr. Jasper Bernard Brewster |
First Address | Nashville, TN 37218-1404 |
Second Address | Nashville, TN 37243-1405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2012 |
Last Update Date | 01/05/2012 |