MEDICARE: DR. JUSTIN LAEL DRAB D.M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	10576	NC

General Provider Information

NPI Number	:	1043241755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN LAEL DRAB D.M.D.

Provider Business Mailing Address
First Line	:	3824 N ELM ST STE 209
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2734
Country	:	US
Telephone Number	:	336-282-7475
Fax Number	:

Provider Business Practice Location Address
First Line	:	3824 N ELM ST STE 209
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2734
Country	:	US
Telephone Number	:	336-282-7475
Fax Number	:

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/21/2022

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