Provider Demographics
NPI:1356418941
Name:FAIRWEATHER, DREW W (DMD)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:W
Last Name:FAIRWEATHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 UNION AVE
Mailing Address - Street 2:BLDG. 2, SUITE A-1
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3002
Mailing Address - Country:US
Mailing Address - Phone:908-722-7902
Mailing Address - Fax:908-722-7057
Practice Address - Street 1:201 UNION AVE
Practice Address - Street 2:BLDG. 2, SUITE A-1
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3002
Practice Address - Country:US
Practice Address - Phone:908-722-7902
Practice Address - Fax:908-722-7057
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ152331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice