Provider Demographics
NPI:1629755129
Name:COOMER, DRAKE CAMBRON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DRAKE
Middle Name:CAMBRON
Last Name:COOMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-2222
Mailing Address - Country:US
Mailing Address - Phone:859-625-4712
Mailing Address - Fax:
Practice Address - Street 1:324 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2199
Practice Address - Country:US
Practice Address - Phone:812-522-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014136A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist