Provider Demographics
NPI:1235439258
Name:DREW, ALLYSON STAAHL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:STAAHL
Last Name:DREW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 RIO DEL MAR BLVD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4771
Mailing Address - Country:US
Mailing Address - Phone:415-994-1231
Mailing Address - Fax:
Practice Address - Street 1:783 RIO DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4771
Practice Address - Country:US
Practice Address - Phone:415-994-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice