Organization
THOMAS K. W. DRAPER, DMD. MD, PLLC
Active
Other names
Trinity Valley Oral Surgery & Dental Implant Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS K DRAPER (OWNER)
(469) 689-0704
Entity
Organization
Contact information
Practice address
215 S FM 548, SUITE C, FORNEY, TX 75126-4129
(469) 689-0704
(469) 689-0709
Mailing address
215 S FM 548, SUITE C, FORNEY, TX 75126-4129
(469) 689-0704
(469) 689-0709
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
24789
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306018320
INDIVIDUAL NPI
TX
05
—
206992419
—
TX
01
—
288152601
FACILITY TPI MEDICAID
TX
01
—
OPT0005
MEDICARE OPT OUT PTAN
TX
Enumeration date
01/17/2012
Last updated
08/23/2012
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