Provider Demographics
NPI:1043241755
Name:DRAB, JUSTIN LAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LAEL
Last Name:DRAB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 N ELM ST STE 209
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2734
Mailing Address - Country:US
Mailing Address - Phone:336-282-7475
Mailing Address - Fax:
Practice Address - Street 1:3824 N ELM ST STE 209
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2734
Practice Address - Country:US
Practice Address - Phone:336-282-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105761223S0112X
PADS0368751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery