Provider Demographics
NPI:1023018264
Name:DRAKE, LAURENCE EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:EARL
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 1:3564 MEMORIAL SHOREWAY
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43440-2366
Mailing Address - Country:US
Mailing Address - Phone:419-798-8027
Mailing Address - Fax:719-798-8027
Practice Address - Street 1:410 BIRCHARD AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2967
Practice Address - Country:US
Practice Address - Phone:419-334-8855
Practice Address - Fax:419-334-8619
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist