Provider Demographics
NPI:1023392479
Name:DRACH, DANIEL J (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:DRACH
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 1:6416 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2203
Mailing Address - Country:US
Mailing Address - Phone:773-631-8800
Mailing Address - Fax:773-631-8808
Practice Address - Street 1:6416 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2203
Practice Address - Country:US
Practice Address - Phone:773-631-8800
Practice Address - Fax:773-631-8808
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190180621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice