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General NPI Number Information
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NPI Number | 1679079891
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Entity Type | Organization
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Legal Business Name | MICHAEL N. DRAKE D.M.D., INC.
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 1243 7TH ST STE A
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City | SANTA MONICA
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State | CA
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Zip | 90401-1658
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Country | US
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Telephone | 310-451-5348
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Fax |
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Provider Business Mailing Address
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Address Line | 1243 7TH ST STE A
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City | SANTA MONICA
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State | CA
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Zip | 90401-1658
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Country | US
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Telephone | 310-451-5348
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL DRAKE
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Credential | DMD
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Telephone | 310-451-5348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 63505
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License Number State | CA
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