Provider Demographics
NPI:1275694879
Name:DRAKE, TERRY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:A
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 1:210 N CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2253
Mailing Address - Country:US
Mailing Address - Phone:218-736-3847
Mailing Address - Fax:218-998-4468
Practice Address - Street 1:210 N CASCADE ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2253
Practice Address - Country:US
Practice Address - Phone:218-736-3847
Practice Address - Fax:218-998-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN94201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice