Drum, Deryl Wayne

Drum, Deryl Wayne is an individual health care provider with primary practice located at 317 Tamarack Lane Suite B, Shiloh IL 62269. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is his primary health care specialty. Drum, Deryl Wayne can be contacted via phone (618) 235-1241.

Contact Information

Primary practice address
317 Tamarack Lane Suite B Shiloh IL 62269
Phone: (618) 235-1241
Fax: (618) 235-7470
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 019021404 Illinois
Dental Providers / Pediatric Dentistry 1223P0221X 021001565 Illinois
Dental Providers / Pediatric Dentistry 1223P0221X 021-001565 Illinois

Profile Details

NPI number 1871668319
LBN Legal business name Drum, Deryl Wayne
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 21st, 2006
Last updated Aug 29th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871668319 NPPES
Illinois MEDICAID 1001718

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