Provider Demographics
NPI:1508305657
Name:DREW POPPER DMD PA
Entity Type:Organization
Organization Name:DREW POPPER DMD PA
Other - Org Name:JUNIOR SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-210-7788
Mailing Address - Street 1:9970 CENTRAL PARK BLVD N STE 305
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2237
Mailing Address - Country:US
Mailing Address - Phone:561-210-7788
Mailing Address - Fax:561-510-2603
Practice Address - Street 1:9970 CENTRAL PARK BLVD N STE 305
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2237
Practice Address - Country:US
Practice Address - Phone:561-210-7788
Practice Address - Fax:561-510-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21755261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106205400Medicaid