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Individual
DR. DERYL WAYNE DRUM
Active
Individual
DR. DERYL WAYNE DRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019021404
IL
1223P0221X
Pediatric Dentistry
Primary
021-001565
IL
1223P0221X
Pediatric Dentistry
021001565
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001718
—
IL
Enumeration date
11/21/2006
Last updated
08/29/2013
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