Provider Demographics
NPI:1902922826
Name:DRAKE, WILLIAM F (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:DRAKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5801
Mailing Address - Country:US
Mailing Address - Phone:865-982-4958
Mailing Address - Fax:865-984-6221
Practice Address - Street 1:406 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5801
Practice Address - Country:US
Practice Address - Phone:865-982-4958
Practice Address - Fax:865-984-6221
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist