Provider Demographics
NPI:1174680516
Name:DREWS,, FRED H III
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:H
Last Name:DREWS,
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SOUTH 40TH AVENUE
Mailing Address - Street 2:PO BOX 17798
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-7798
Mailing Address - Country:US
Mailing Address - Phone:601-264-5100
Mailing Address - Fax:601-264-6669
Practice Address - Street 1:313 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1734
Practice Address - Country:US
Practice Address - Phone:601-264-5100
Practice Address - Fax:601-264-6669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1453-71122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist