Provider Demographics
NPI:1891901534
Name:THOMAS C DREW,IV,DDS,PA
Entity Type:Organization
Organization Name:THOMAS C DREW,IV,DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DREW
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-445-5998
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:252-445-2404
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992206Medicaid
NCU38086Medicare UPIN