Individual
DEANNA NICOLE S DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2436 S ACADEMY BLVD, COLORADO SPRINGS, CO 80916-2408
(719) 391-2336
(719) 391-1625
Mailing address
2221 E BIJOU ST STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 576-1850
(719) 955-3470
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN.00203739
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558801928
—
CO
01
—
DEN.00203739
CO DENTAL LICENSE
CO
Enumeration date
03/03/2017
Last updated
06/13/2019
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