Provider Demographics
NPI:1851454334
Name:RAKE, SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:RAKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 CLIFF RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2485
Mailing Address - Country:US
Mailing Address - Phone:651-452-6933
Mailing Address - Fax:651-905-3061
Practice Address - Street 1:2130 CLIFF RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2485
Practice Address - Country:US
Practice Address - Phone:651-452-6933
Practice Address - Fax:651-905-3061
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND109611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU93196Medicare UPIN