Provider Demographics
NPI:1386801298
Name:DR.THOMAS E. DRAKE
Entity type:Organization
Organization Name:DR.THOMAS E. DRAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-792-0515
Mailing Address - Street 1:1519 HIGHWAY 22 W
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9489
Mailing Address - Country:US
Mailing Address - Phone:985-792-0515
Mailing Address - Fax:985-792-0517
Practice Address - Street 1:1519 HIGHWAY 22 W
Practice Address - Street 2:SUITE #3
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9489
Practice Address - Country:US
Practice Address - Phone:985-792-0515
Practice Address - Fax:985-792-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA26381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1880132Medicaid