Provider Demographics
NPI:1467103614
Name:DREW RODNEY DENTISTRY
Entity Type:Organization
Organization Name:DREW RODNEY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RODNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-412-9645
Mailing Address - Street 1:686 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1012
Mailing Address - Country:US
Mailing Address - Phone:207-772-8112
Mailing Address - Fax:
Practice Address - Street 1:686 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1012
Practice Address - Country:US
Practice Address - Phone:207-772-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental