Healthcare Provider Details

I. General information

NPI: 1316475932
Provider Name (Legal Business Name): DAVID STERLING DRAKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 MEDICAL CENTER PT STE 101
COLORADO SPRINGS CO
80907-5765
US

IV. Provider business mailing address

1644 MEDICAL CENTER PT STE 101
COLORADO SPRINGS CO
80907-5765
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-4060
  • Fax: 719-574-2140
Mailing address:
  • Phone: 719-597-4060
  • Fax: 719-574-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN.00206367
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10387645-9922
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401417940
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: