Provider Demographics
NPI:1952029928
Name:DREW DENTAL CORP
Entity Type:Organization
Organization Name:DREW DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-355-5023
Mailing Address - Street 1:783 RIO DEL MAR BLVD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4771
Mailing Address - Country:US
Mailing Address - Phone:408-355-5023
Mailing Address - Fax:408-688-4312
Practice Address - Street 1:783 RIO DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4771
Practice Address - Country:US
Practice Address - Phone:408-688-6060
Practice Address - Fax:408-688-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235439258OtherNPI
1578713475OtherNPI