Provider Demographics
NPI:1013567080
Name:KATRINA J DREW, DDS, PC
Entity Type:Organization
Organization Name:KATRINA J DREW, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-686-2446
Mailing Address - Street 1:748 GOODPASTURE ISLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-686-2446
Mailing Address - Fax:541-686-3055
Practice Address - Street 1:748 GOODPASTURE ISLAND ROAD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-686-2446
Practice Address - Fax:541-686-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150577Medicaid