Provider Demographics
NPI:1023310729
Name:DRAKE, ZACHARY EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:EDWARD
Last Name:DRAKE
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 1:8 NORTH 2ND STREET WEST
Mailing Address - Street 2:
Mailing Address - City:HOMEDALE
Mailing Address - State:ID
Mailing Address - Zip Code:83628-3160
Mailing Address - Country:US
Mailing Address - Phone:208-337-6101
Mailing Address - Fax:208-466-5359
Practice Address - Street 1:1930 9TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4759
Practice Address - Country:US
Practice Address - Phone:406-533-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-42921223G0001X
MTDEN-DEN-LIC-223121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice