Provider Demographics
NPI:1225773385
Name:DRAKE, JEFFREY GEORGE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GEORGE
Last Name:DRAKE
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 W SURF ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6198
Mailing Address - Country:US
Mailing Address - Phone:309-287-2822
Mailing Address - Fax:
Practice Address - Street 1:9535 W 144TH PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-9503
Practice Address - Country:US
Practice Address - Phone:708-460-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0323441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics