Individual
DR. CARL THOMAS DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
310 SUSAN DR, STE 1, NORMAL, IL 61761-6206
(309) 808-0054
Mailing address
310 SUSAN DRIVE, SUITE 1, NORMAL, IL 61761
(309) 808-0054
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.027428
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
021.002368
IL
Other
Enumeration date
07/17/2007
Last updated
05/27/2011
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