Healthcare Provider Details

I. General information

NPI: 1427271923
Provider Name (Legal Business Name): KATRINA J. DREW D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 GOODPASTURE ISLAND ROAD
EUGENE OR
97401
US

IV. Provider business mailing address

748 GOODPASTURE ISLAND ROAD
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-2446
  • Fax: 541-686-3055
Mailing address:
  • Phone: 541-686-2446
  • Fax: 541-686-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD7327
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier150577
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: