Provider Demographics
NPI:1104987478
Name:DRAKE, RICHARD BRADLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRADLEY
Last Name:DRAKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14603 HUEBNER RD BLDG 4
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5473
Mailing Address - Country:US
Mailing Address - Phone:210-541-9001
Mailing Address - Fax:210-579-7200
Practice Address - Street 1:14603 HUEBNER RD BLDG 4
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5473
Practice Address - Country:US
Practice Address - Phone:210-541-9001
Practice Address - Fax:210-698-3845
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15907204E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery