Provider Demographics
NPI:1922407964
Name:POPPER, DREW
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:POPPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9970 CENTRAL PARK BLVD N STE 305
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2237
Mailing Address - Country:US
Mailing Address - Phone:561-210-7788
Mailing Address - Fax:561-510-2603
Practice Address - Street 1:9970 CENTRAL PARK BLVD N STE 305
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2237
Practice Address - Country:US
Practice Address - Phone:561-210-7788
Practice Address - Fax:561-510-2603
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN217551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017151100Medicaid