Healthcare Provider Details

I. General information

NPI: 1851603385
Provider Name (Legal Business Name): ERIN RAKE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N DAN JONES RD
PLAINFIELD IN
46168-1874
US

IV. Provider business mailing address

167 N DAN JONES RD
PLAINFIELD IN
46168-1874
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-2088
  • Fax:
Mailing address:
  • Phone: 317-839-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12011508A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: