Provider Demographics
NPI:1942759865
Name:DREW A. HEBERER, DDS, PLLC
Entity Type:Organization
Organization Name:DREW A. HEBERER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:ANSLEY
Authorized Official - Last Name:HEBERER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-392-8564
Mailing Address - Street 1:3803 COMPUTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3803 COMPUTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6541
Practice Address - Country:US
Practice Address - Phone:919-781-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty