Provider Demographics
NPI:1922161140
Name:DREW, RICHARD ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
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 1:1044 SW 44TH ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3613
Mailing Address - Country:US
Mailing Address - Phone:405-632-6601
Mailing Address - Fax:405-632-6031
Practice Address - Street 1:1044 SW 44TH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3613
Practice Address - Country:US
Practice Address - Phone:405-632-6601
Practice Address - Fax:405-632-6031
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice