MEDICARE: DREW ADDY DDS INC.

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	261QD0000X	Dental Clinic/Center	64006	CA

General Provider Information

NPI Number	:	1770965055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREW ADDY DDS INC.

Provider Business Mailing Address
First Line	:	13928 MISTY OAK RD
Second Line	:
City	:	VALLEY CENTER
State	:	CA
Zip	:	92082-5812
Country	:	US
Telephone Number	:	213-925-0210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2879 HOPE AVE
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1833
Country	:	US
Telephone Number	:	213-925-0210
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/PRESIDENT
Name	:	DR. DREW KEVIN ADDY
Credential	:	D.D.S
Telephone Number	:	213-925-0210

Provider Enumeration Date	:	06/23/2015
Last Update Date	:	06/23/2015

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