Provider Demographics
NPI:1265617518
Name:JUSTIN L DRAB, DMD, PA
Entity type:Organization
Organization Name:JUSTIN L DRAB, DMD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRAB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-282-7475
Mailing Address - Street 1:3824 N ELM ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2596
Mailing Address - Country:US
Mailing Address - Phone:336-282-7475
Mailing Address - Fax:336-282-7929
Practice Address - Street 1:3824 N ELM ST
Practice Address - Street 2:SUITE 209
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2596
Practice Address - Country:US
Practice Address - Phone:336-282-7475
Practice Address - Fax:336-282-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty