Provider Demographics
NPI:1093932923
Name:DRAKE, DONALD A II (DDS,MSD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:DRAKE
Suffix:II
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2677
Mailing Address - Country:US
Mailing Address - Phone:605-335-6665
Mailing Address - Fax:605-332-5510
Practice Address - Street 1:5100 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2677
Practice Address - Country:US
Practice Address - Phone:605-335-6665
Practice Address - Fax:605-332-5510
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM4061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1407074586OtherORTHODONTICS