Provider Demographics
NPI:1134218407
Name:DRABS, DAVID BERNARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BERNARD
Last Name:DRABS
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 1:1000 N SILVERBELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:520-624-7514
Mailing Address - Fax:520-624-7522
Practice Address - Street 1:1000 N SILVERBELL RD
Practice Address - Street 2:PUEBLO DENTAL MANAGEMENT INC
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-624-7514
Practice Address - Fax:520-624-7522
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ084559Medicaid
1371004OtherGP # UNITED CONCORDIA
54038OtherSAFEGUARD
593382OtherINDIVID # UNITED CONCORDI
AZAZ0471070OtherBCBS OF AZ