Provider Demographics
NPI:1588193049
Name:KIMBERLY MICHELE DRAPER, DDS PLLC
Entity Type:Organization
Organization Name:KIMBERLY MICHELE DRAPER, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-254-2459
Mailing Address - Street 1:10419 LEMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-4415
Mailing Address - Country:US
Mailing Address - Phone:704-254-2459
Mailing Address - Fax:
Practice Address - Street 1:331 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3904
Practice Address - Country:US
Practice Address - Phone:704-982-2216
Practice Address - Fax:888-875-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty