MEDICARE: ADH DRAKE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1255288601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADH DRAKE PLLC

Provider Business Mailing Address
First Line	:	15660 DALLAS PKWY STE 950
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-3309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 W DRAKE RD STE B2
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6031
Country	:	US
Telephone Number	:	214-702-0708
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	AMANDA LIGHTFOOT
Credential	:
Telephone Number	:	214-702-0708

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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Directions to “ADH DRAKE PLLC ” Practice Location

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