Provider Demographics
NPI:1003154501
Name:DRAKE, MICHAEL A (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:DRAKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13040 LIVINGSTON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5025
Mailing Address - Country:US
Mailing Address - Phone:239-566-2255
Mailing Address - Fax:
Practice Address - Street 1:13040 LIVINGSTON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-5025
Practice Address - Country:US
Practice Address - Phone:239-566-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN83261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice