Provider Demographics
NPI:1730315441
Name:DRAHOS, GARY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:DRAHOS
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 1:10 COVE CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8369
Mailing Address - Country:US
Mailing Address - Phone:630-323-4558
Mailing Address - Fax:
Practice Address - Street 1:10 COVE CT
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-8369
Practice Address - Country:US
Practice Address - Phone:630-323-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist