Provider Demographics
NPI:1659527505
Name:JOE DRAKE DDS A PROFESSIONAL ASSOCTIATION
Entity Type:Organization
Organization Name:JOE DRAKE DDS A PROFESSIONAL ASSOCTIATION
Other - Org Name:DRAKE DENTISTRY OF CHARLOTTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-338-9797
Mailing Address - Street 1:1716 KENILWORTH AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6086
Mailing Address - Country:US
Mailing Address - Phone:704-338-9797
Mailing Address - Fax:704-379-7972
Practice Address - Street 1:1716 KENILWORTH AVE STE 180
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6086
Practice Address - Country:US
Practice Address - Phone:704-338-9797
Practice Address - Fax:704-379-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty