Provider Demographics
NPI:1760581771
Name:DRAKE, SANDRA KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:KAY
Last Name:DRAKE
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 1:145 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1240
Mailing Address - Country:US
Mailing Address - Phone:540-459-2512
Mailing Address - Fax:540-459-7269
Practice Address - Street 1:145 W SPRING ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1240
Practice Address - Country:US
Practice Address - Phone:540-459-2512
Practice Address - Fax:540-459-7269
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106831223G0001X
WV35121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA289017OtherBLUE CROSS/BLUE SHIELD