Provider Demographics
NPI:1720143811
Name:DREW, ANTHEA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHEA
Middle Name:
Last Name:DREW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WALESKA RD
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2493
Mailing Address - Country:US
Mailing Address - Phone:404-275-8443
Mailing Address - Fax:404-479-1747
Practice Address - Street 1:205 WALESKA RD
Practice Address - Street 2:SUITE 2-B
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2493
Practice Address - Country:US
Practice Address - Phone:404-275-8443
Practice Address - Fax:404-479-1747
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0134141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN013414OtherLICENSE
DN013414OtherLICENSE