Provider Demographics
NPI:1922346774
Name:ADDY, DREW KEVIN (DDS)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:KEVIN
Last Name:ADDY
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 1:2879 HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1833
Mailing Address - Country:US
Mailing Address - Phone:760-729-5881
Mailing Address - Fax:
Practice Address - Street 1:1184 W 30TH ST
Practice Address - Street 2:APARTMENT #8
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3183
Practice Address - Country:US
Practice Address - Phone:213-925-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist