Provider Demographics
NPI:1518019561
Name:DRAKE, VANESSA MCDADE (DDS)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MCDADE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-3334
Mailing Address - Country:US
Mailing Address - Phone:423-894-0052
Mailing Address - Fax:423-894-7584
Practice Address - Street 1:4216 CROSS ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-3334
Practice Address - Country:US
Practice Address - Phone:423-894-0052
Practice Address - Fax:423-894-7584
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000008538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist