Provider Demographics
NPI:1891744900
Name:DRACUP, DANIEL VICTOR (DDS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:VICTOR
Last Name:DRACUP
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:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787
Mailing Address - Country:US
Mailing Address - Phone:828-645-3482
Mailing Address - Fax:828-645-3703
Practice Address - Street 1:18 MOORE ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787
Practice Address - Country:US
Practice Address - Phone:828-645-3482
Practice Address - Fax:828-645-3703
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist