Healthcare Provider Details

I. General information

NPI: 1134317845
Provider Name (Legal Business Name): TOBIN NORMAN DRAKE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 W DODGE RD STE 301
OMAHA NE
68114-3318
US

IV. Provider business mailing address

9202 W DODGE RD STE 301
OMAHA NE
68114-3318
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-3636
  • Fax: 402-397-1055
Mailing address:
  • Phone: 402-397-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number08496
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: