1326194762 NPI number — R. DRAKE COVEY DDS LTD

Table of content: (NPI 1326194762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326194762 NPI number — R. DRAKE COVEY DDS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R. DRAKE COVEY DDS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326194762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7802 TIMBERLAKE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-239-6948
Provider Business Mailing Address Fax Number:
434-239-9158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CANDLEWOOD COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-239-6948
Provider Business Practice Location Address Fax Number:
434-239-9158
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COVEY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
DRAKE
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
434-239-6948

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  0401005417 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X , with the licence number: 0401004221 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010053781 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15487 . This is a "R DRAKE COVEY DORAL #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008214166 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106512 . This is a "THOMAS E DOYLE DORAL #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225107469 . This is a "THOMAS E DOYLE NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881790897 . This is a "R. DRAKE COVEY NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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