Provider Demographics
NPI:1164086153
Name:RODNEY, DREW CHRISTIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:CHRISTIAN
Last Name:RODNEY
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 1:33 JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3901
Mailing Address - Country:US
Mailing Address - Phone:415-412-9645
Mailing Address - Fax:
Practice Address - Street 1:6 WELLSPRING RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9415
Practice Address - Country:US
Practice Address - Phone:207-283-1752
Practice Address - Fax:207-283-1415
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4706122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist