Individual
DRAKE GLEN VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., DMD
Contact information
Practice address
1710 E 5600 S, OGDEN, UT 84403-4384
(801) 475-4475
(801) 475-4476
Mailing address
1710 E 5600 S, OGDEN, UT 84403-4384
(801) 475-4475
(801) 475-4476
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5767298-1205
UT
Other
Enumeration date
03/14/2007
Last updated
11/08/2007
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