Provider Demographics
NPI:1427271923
Name:DREW, KATRINA J (DDS)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:J
Last Name:DREW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 GOODPASTURE ISLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-686-2446
Mailing Address - Fax:541-686-3055
Practice Address - Street 1:748 GOODPASTURE ISLAND ROAD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-686-2446
Practice Address - Fax:541-686-3055
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD73271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150577Medicaid