Provider Demographics
NPI:1710265525
Name:RAKES, POTA ANGIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:POTA
Middle Name:ANGIE
Last Name:RAKES
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 1:22801 NEWMAN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2200
Mailing Address - Country:US
Mailing Address - Phone:313-274-8522
Mailing Address - Fax:313-274-5396
Practice Address - Street 1:22801 NEWMAN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2200
Practice Address - Country:US
Practice Address - Phone:313-274-8522
Practice Address - Fax:313-274-5396
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist