Provider Demographics
NPI:1427441476
Name:DRAKE DENTAL CARE PROFESSIONALS, LLC
Entity type:Organization
Organization Name:DRAKE DENTAL CARE PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WUERKER
Authorized Official - Suffix:
Authorized Official - Credentials:D,D,S,
Authorized Official - Phone:970-407-8080
Mailing Address - Street 1:140 BOARDWALK DR
Mailing Address - Street 2:UNIT G
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3153
Mailing Address - Country:US
Mailing Address - Phone:970-407-8080
Mailing Address - Fax:970-221-3590
Practice Address - Street 1:140 BOARDWALK DR
Practice Address - Street 2:UNIT G
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3153
Practice Address - Country:US
Practice Address - Phone:970-407-8080
Practice Address - Fax:970-221-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty