Provider Demographics
NPI:1619055084
Name:DRAKE, LAWRENCE ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ALLEN
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 1:3603 LAS VEGAS BLVD N
Mailing Address - Street 2:STE #122
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0588
Mailing Address - Country:US
Mailing Address - Phone:702-643-7720
Mailing Address - Fax:702-643-0538
Practice Address - Street 1:3603 LAS VEGAS BLVD N
Practice Address - Street 2:STE #122
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0588
Practice Address - Country:US
Practice Address - Phone:702-643-7720
Practice Address - Fax:702-643-0538
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV27881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice