Provider Demographics
NPI:1093937062
Name:DRURY, GERALD IRWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:IRWIN
Last Name:DRURY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 PACIFIC COAST HWY
Mailing Address - Street 2:F
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254
Mailing Address - Country:US
Mailing Address - Phone:310-376-9884
Mailing Address - Fax:
Practice Address - Street 1:1100 PACIFIC COAST HWY
Practice Address - Street 2:F
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254
Practice Address - Country:US
Practice Address - Phone:310-376-9884
Practice Address - Fax:310-318-1573
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics