MEDICARE: STEPHANIE IRENE DRAKE DDS

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	1223P0300X	Periodontics	11199	SC

General Provider Information

NPI Number	:	1376287441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE IRENE DRAKE DDS

Provider Business Mailing Address
First Line	:	600 CONGAREE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-3518
Country	:	US
Telephone Number	:	864-757-8820
Fax Number	:	864-751-5825

Provider Business Practice Location Address
First Line	:	600 CONGAREE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-3518
Country	:	US
Telephone Number	:	864-757-8820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	11/11/2025

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