Healthcare Provider Details

I. General information

NPI: 1881764116
Provider Name (Legal Business Name): THOMAS D DRAKOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8963 BROADWAY
MERRILLVILLE IN
46410-7039
US

IV. Provider business mailing address

8963 BROADWAY
MERRILLVILLE IN
46410-7039
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-0744
  • Fax: 219-769-0768
Mailing address:
  • Phone: 219-769-0744
  • Fax: 219-769-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12008969
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: