Provider Demographics
NPI:1164758413
Name:DRAKE, YESENIA M (DDS)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:M
Last Name:DRAKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:YESENIA
Other - Middle Name:M
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:725 NORTH STREET
Mailing Address - Street 2:BERKSHIRE MEDICAL CENTER
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-447-2781
Mailing Address - Fax:413-395-7922
Practice Address - Street 1:725 NORTH STREET
Practice Address - Street 2:BERKSHIRE MEDICAL CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-447-2781
Practice Address - Fax:413-395-7922
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL105701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice