Provider Demographics
NPI:1326194762
Name:R. DRAKE COVEY DDS LTD
Entity Type:Organization
Organization Name:R. DRAKE COVEY DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DRAKE
Authorized Official - Last Name:COVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-239-6948
Mailing Address - Street 1:7802 TIMBERLAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502
Mailing Address - Country:US
Mailing Address - Phone:434-239-6948
Mailing Address - Fax:434-239-9158
Practice Address - Street 1:101 CANDLEWOOD COURT
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502
Practice Address - Country:US
Practice Address - Phone:434-239-6948
Practice Address - Fax:434-239-9158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010054171223P0221X
VA04010042211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010053781Medicaid
VA15487OtherR DRAKE COVEY DORAL #
VA008214166Medicaid
VA106512OtherTHOMAS E DOYLE DORAL #
VA1225107469OtherTHOMAS E DOYLE NPI
VA1881790897OtherR. DRAKE COVEY NPI