1134218407 NPI number — DR. DAVID BERNARD DRABS DDS

Table of content: DR. DAVID BERNARD DRABS DDS (NPI 1134218407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134218407 NPI number — DR. DAVID BERNARD DRABS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRABS
Provider First Name:
DAVID
Provider Middle Name:
BERNARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134218407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 N SILVERBELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-624-7514
Provider Business Mailing Address Fax Number:
520-624-7522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N SILVERBELL RD
Provider Second Line Business Practice Location Address:
PUEBLO DENTAL MANAGEMENT INC
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-624-7514
Provider Business Practice Location Address Fax Number:
520-624-7522
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2466 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 084559 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1371004 . This is a "GP # UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54038 . This is a "SAFEGUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 593382 . This is a "INDIVID # UNITED CONCORDI" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ0471070 . This is a "BCBS OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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