Individual
ALBERT EUGENE DRAKE JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8819 N 145TH E AVE, OWASSO, OK 74055
(918) 272-5381
(918) 274-0815
Mailing address
PO BOX 898, OWASSO, OK 74055
(918) 272-5381
(918) 274-0815
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4019
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059363
UNITED CONCORDIA
—
01
—
731072535001
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/12/2006
Last updated
07/08/2007
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