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General NPI Number Information
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NPI Number | 1174042139
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Entity Type | Organization
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Legal Business Name | ABBEY DENTAL DRAKE, PLLC
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4408 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89119-7825
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Country | US
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Telephone | 702-731-5700
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Fax | 702-731-0803
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Provider Business Mailing Address
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Address Line | 4408 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89119-7825
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Country | US
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Telephone | 702-731-5700
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Fax | 702-731-0803
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Authorized Official
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Title or Position | ACCOUNTS
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Name | SUSAN RODRIGUEZ
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Credential |
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Telephone | 702-731-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2788
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License Number State | NV
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