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General NPI Number Information
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NPI Number | 1417371345
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Entity Type | Organization
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Legal Business Name | DR. DRAAK DAVIS FAMILY DENTAL
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 1624 FRANKLIN ST SUITE 1206
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City | OAKLAND
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State | CA
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Zip | 94612-2897
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Country | US
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Telephone | 510-465-5555
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Fax | 510-836-8799
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Provider Business Mailing Address
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Address Line | 1624 FRANKLIN ST SUITE 1206
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City | OAKLAND
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State | CA
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Zip | 94612-2897
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Country | US
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Telephone | 510-465-5555
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Fax | 510-836-8799
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Authorized Official
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Title or Position | OWNER
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Name | DRAAK KARRAS DAVIS
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Credential | DMD
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Telephone | 510-465-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 60565
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License Number State | CA
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