Provider Demographics
NPI:1861401697
Name:OCIE DRAKE, JR, DDS, PC
Entity type:Organization
Organization Name:OCIE DRAKE, JR, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-646-6966
Mailing Address - Street 1:18161 W 13 MILE RD
Mailing Address - Street 2:SUITE D1
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1113
Mailing Address - Country:US
Mailing Address - Phone:248-646-6966
Mailing Address - Fax:248-646-4558
Practice Address - Street 1:18161 W 13 MILE RD
Practice Address - Street 2:SUITE D1
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1113
Practice Address - Country:US
Practice Address - Phone:248-646-6966
Practice Address - Fax:248-646-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty