Provider Demographics
NPI:1578713475
Name:DREW, JASON KANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:KANE
Last Name:DREW
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 1:783 RIO DEL MAR BLVD FRNT
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4702
Mailing Address - Country:US
Mailing Address - Phone:831-688-6060
Mailing Address - Fax:831-688-4312
Practice Address - Street 1:783 RIO DEL MAR BLVD FRNT
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4702
Practice Address - Country:US
Practice Address - Phone:831-688-6060
Practice Address - Fax:831-688-4312
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist