Provider Demographics
NPI:1245672211
Name:VAN DREW DENTISTRY, P.C.
Entity type:Organization
Organization Name:VAN DREW DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DREW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-641-0016
Mailing Address - Street 1:38 E DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-3009
Mailing Address - Country:US
Mailing Address - Phone:609-641-0016
Mailing Address - Fax:609-641-3508
Practice Address - Street 1:38 E DECATUR AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3009
Practice Address - Country:US
Practice Address - Phone:609-641-0016
Practice Address - Fax:609-641-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01223100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty