Provider Demographics
NPI:1871643809
Name:DRAPER, JAMES VERNON (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:VERNON
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 1:10985 N LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48852
Mailing Address - Country:US
Mailing Address - Phone:989-352-7463
Mailing Address - Fax:
Practice Address - Street 1:924 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850
Practice Address - Country:US
Practice Address - Phone:989-352-7294
Practice Address - Fax:989-352-8348
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5597120OtherBCBS DENTAL SURGERY
MI4006325Medicaid
MID092260OtherBCBS DENTAL
598183OtherUNITED CONCORDIA PROVIDER
598183OtherUNITED CONCORDIA PROVIDER
598183OtherUNITED CONCORDIA PROVIDER
MIP04500001Medicare ID - Type Unspecified