Provider Demographics
NPI:1780649202
Name:DREW, STEPHANIE JOY (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JOY
Last Name:DREW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON RD NE BLDG B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-4555
Mailing Address - Fax:404-778-5879
Practice Address - Street 1:1365 CLIFTON RD NE STE 2300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4405
Practice Address - Country:US
Practice Address - Phone:404-778-4555
Practice Address - Fax:404-778-5879
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428291223X0008X, 1223X0400X, 1223P0106X, 1223S0112X, 204E00000X
GADN0153851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01463525Medicaid
NYU40689Medicare UPIN