Provider Demographics
NPI:1376252916
Name:DREW DENTISTRY
Entity Type:Organization
Organization Name:DREW DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-271-4815
Mailing Address - Street 1:9125 BRIDGEPORT WAY SW STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2448
Mailing Address - Country:US
Mailing Address - Phone:253-581-6140
Mailing Address - Fax:253-294-9990
Practice Address - Street 1:9125 BRIDGEPORT WAY SW STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2448
Practice Address - Country:US
Practice Address - Phone:253-581-6140
Practice Address - Fax:253-294-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental