Provider Demographics
NPI:1689236788
Name:DRAKE, DONICA ELISE (SA)
Entity Type:Individual
Prefix:MRS
First Name:DONICA
Middle Name:ELISE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:SA
Other - Prefix:
Other - First Name:DONICA
Other - Middle Name:ELISE
Other - Last Name:BUCKMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SA
Mailing Address - Street 1:595 CHAPEL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1022
Mailing Address - Country:US
Mailing Address - Phone:719-599-0500
Mailing Address - Fax:719-599-0575
Practice Address - Street 1:595 CHAPEL HILLS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1022
Practice Address - Country:US
Practice Address - Phone:719-599-0500
Practice Address - Fax:719-599-0575
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant