Provider Demographics
NPI:1205852944
Name:DRAKE, THOMAS A (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:DRAKE
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 1:140 N 130TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-9142
Mailing Address - Country:US
Mailing Address - Phone:913-721-1300
Mailing Address - Fax:913-721-1430
Practice Address - Street 1:140 N 130TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-9142
Practice Address - Country:US
Practice Address - Phone:913-721-1300
Practice Address - Fax:913-721-1430
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS88351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice