Provider Demographics
NPI:1871972448
Name:DANIEL K. DRAKULICH, DDS, PC
Entity type:Organization
Organization Name:DANIEL K. DRAKULICH, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:DRAKULICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-249-9811
Mailing Address - Street 1:747 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5712
Mailing Address - Country:US
Mailing Address - Phone:970-249-9811
Mailing Address - Fax:
Practice Address - Street 1:747 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5712
Practice Address - Country:US
Practice Address - Phone:970-249-9811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty