Provider Demographics
NPI:1588702039
Name:DRAKE, ANITA T (DDS)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:T
Last Name:DRAKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 PACKETTS LNDG
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1569
Mailing Address - Country:US
Mailing Address - Phone:585-223-9510
Mailing Address - Fax:
Practice Address - Street 1:260 PACKETTS LNDG
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1569
Practice Address - Country:US
Practice Address - Phone:585-223-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0401951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice