Individual
THOMAS K. W. DRAPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
215 S. FM 548, SUITE C, FORNEY, TX 75126
(469) 689-0704
(469) 689-0709
Mailing address
215 S. FM 548, SUITE C, FORNEY, TX 75126
(469) 689-0704
(469) 689-0709
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
24789
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
B226-X
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700157146
FACILITY NPI
TX
05
—
206992419
—
TX
01
—
288152601
FACILITY TPI MEDICAID
TX
01
—
OPT0005
MEDICARE OPT OUT PTAN
TX
Enumeration date
03/31/2008
Last updated
09/07/2012
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