Provider Demographics
NPI:1114083789
Name:DRAPER, MATHEW HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:HENRY
Last Name:DRAPER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 W 165TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8113
Mailing Address - Country:US
Mailing Address - Phone:970-980-5920
Mailing Address - Fax:
Practice Address - Street 1:651 E US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2974
Practice Address - Country:US
Practice Address - Phone:970-980-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT378878-99221223G0001X
CO89001223G0001X
MO20080345271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice