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General NPI Number Information
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NPI Number | 1316007859
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Entity Type | Organization
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Legal Business Name | DRS DRAKE LTD
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 515 PEARL STREET
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City | BELVIDERE
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State | IL
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Zip | 61008
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Country | US
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Telephone | 815-547-8112
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Fax | 815-544-5480
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Provider Business Mailing Address
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Address Line | 515 PEARL STREET
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City | BELVIDERE
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State | IL
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Zip | 61008
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Country | US
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Telephone | 815-547-8112
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Fax | 815-544-5480
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. DALE ADDISON DRAKE
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Credential | DDS
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Telephone | 815-547-8112
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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 | 1917128
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1915991
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License Number State | IL
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