Provider Demographics
NPI:1407863632
Name:SMITH, DREW G (DDS)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:G
Last Name:SMITH
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:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-1289
Mailing Address - Country:US
Mailing Address - Phone:603-356-9755
Mailing Address - Fax:603-356-9754
Practice Address - Street 1:3277 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5113
Practice Address - Country:US
Practice Address - Phone:603-356-9755
Practice Address - Fax:603-356-9754
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH24291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80001244Medicaid
NHT23040OtherHARVARD PILGRIM PROVIDER
NH0202960Y0NH01OtherANTHEM PROVIDER NUMBER
NHT23040Medicare UPIN
NHRE1244Medicare ID - Type UnspecifiedMEDICARE NUMBER