Provider Demographics
NPI:1548348915
Name:LAWRENCE A DRAKE DDS LTD
Entity type:Organization
Organization Name:LAWRENCE A DRAKE DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-643-7720
Mailing Address - Street 1:3603 LAS VEGAS BLVD N
Mailing Address - Street 2:STE #122
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0588
Mailing Address - Country:US
Mailing Address - Phone:702-643-7720
Mailing Address - Fax:702-643-0538
Practice Address - Street 1:3603 LAS VEGAS BLVD N
Practice Address - Street 2:STE #122
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0588
Practice Address - Country:US
Practice Address - Phone:702-643-7720
Practice Address - Fax:702-643-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2788261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental