Provider Demographics
NPI:1851341481
Name:DRAKE, ALBERT EUGENE JR (DDS)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:EUGENE
Last Name:DRAKE
Suffix:JR
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:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055
Mailing Address - Country:US
Mailing Address - Phone:918-272-5381
Mailing Address - Fax:918-274-0815
Practice Address - Street 1:8819 N 145TH E AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055
Practice Address - Country:US
Practice Address - Phone:918-272-5381
Practice Address - Fax:918-274-0815
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
731072535001OtherBLUE CROSS BLUE SHIELD
059363OtherUNITED CONCORDIA
731072535001OtherBLUE CROSS BLUE SHIELD