Healthcare Provider Details

I. General information

NPI: 1265617518
Provider Name (Legal Business Name): JUSTIN L DRAB, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 N ELM ST SUITE 209
GREENSBORO NC
27455-2596
US

IV. Provider business mailing address

3824 N ELM ST SUITE 209
GREENSBORO NC
27455-2596
US

V. Phone/Fax

Practice location:
  • Phone: 336-282-7475
  • Fax: 336-282-7929
Mailing address:
  • Phone: 336-282-7475
  • Fax: 336-282-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN L DRAB
Title or Position: ORAL & MAXILLOFACIAL SURGEON
Credential: DMD
Phone: 336-282-7475