Provider Demographics
NPI:1679264923
Name:DREW DENTISTRY PLLC
Entity Type:Organization
Organization Name:DREW DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-374-2400
Mailing Address - Street 1:1821 N TREKELL RD STE 9
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1705
Mailing Address - Country:US
Mailing Address - Phone:520-374-2400
Mailing Address - Fax:520-836-7469
Practice Address - Street 1:1821 N TREKELL RD STE 9
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1705
Practice Address - Country:US
Practice Address - Phone:520-374-2400
Practice Address - Fax:520-836-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental