Healthcare Provider Details

I. General information

NPI: 1124514526
Provider Name (Legal Business Name): THOMAS A DRAKE DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N 130TH ST
BONNER SPRINGS KS
66012-9142
US

IV. Provider business mailing address

140 N 130TH ST
BONNER SPRINGS KS
66012-9142
US

V. Phone/Fax

Practice location:
  • Phone: 913-325-0120
  • Fax:
Mailing address:
  • Phone: 913-325-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: THOMAS DRAKE
Title or Position: DENTIST
Credential:
Phone: 913-325-0120