MEDICARE: DR. DREW GOTTWALD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	100261115	WI

General Provider Information

NPI Number	:	1467031203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DREW GOTTWALD DDS

Provider Business Mailing Address
First Line	:	968 1ST INFANTRY DIVISION RD
Second Line	:
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5210
Country	:	US
Telephone Number	:	502-626-8303
Fax Number	:	502-626-8300

Provider Business Practice Location Address
First Line	:	968 1ST INFANTRY DIVISION RD
Second Line	:
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5210
Country	:	US
Telephone Number	:	502-626-8303
Fax Number	:	502-626-8300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	01/21/2026

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