Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 10576 | NC |
NPI | 1043241755 |
---|---|
Provider Name | Dr. Justin Lael Drab |
First Address | Greensboro, NC 27455-2734 |
Second Address | Greensboro, NC 27455-2734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 17/03/2018 |