Provider Demographics
NPI:1467455444
Name:DREW, THOMAS CHAMPION IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHAMPION
Last Name:DREW
Suffix:IV
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 485
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27823-0485
Mailing Address - Country:US
Mailing Address - Phone:252-445-5998
Mailing Address - Fax:
Practice Address - Street 1:117 GLENVIEW RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NC
Practice Address - Zip Code:27823-1324
Practice Address - Country:US
Practice Address - Phone:252-445-5998
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899-2206Medicaid
NCU38086Medicare UPIN