Provider Demographics
NPI:1306018320
Name:DRAPER, THOMAS K W (DMD, MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:K W
Last Name:DRAPER
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S. FM 548
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126
Mailing Address - Country:US
Mailing Address - Phone:469-689-0704
Mailing Address - Fax:469-689-0709
Practice Address - Street 1:215 S. FM 548
Practice Address - Street 2:SUITE C
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126
Practice Address - Country:US
Practice Address - Phone:469-689-0704
Practice Address - Fax:469-689-0709
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB226-X1223S0112X
TX247891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288152601OtherFACILITY TPI MEDICAID
TX206992419Medicaid
TX1700157146OtherFACILITY NPI
TXOPT0005OtherMEDICARE OPT OUT PTAN