Healthcare Provider Details

I. General information

NPI: 1821128489
Provider Name (Legal Business Name): JENNIFER LYNN DREW D.D.S., M.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 EL CAMINO AVENUE STE. 6
SACRAMENTO CA
95821
US

IV. Provider business mailing address

3960 EL CAMINO AVE STE 6
SACRAMENTO CA
95821-6534
US

V. Phone/Fax

Practice location:
  • Phone: 916-489-0852
  • Fax: 916-489-1517
Mailing address:
  • Phone: 916-489-0852
  • Fax: 916-489-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number38517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: