Provider Demographics
NPI:1922413467
Name:DRAPER, ERIC R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:R
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 1:520 E WHIDBEY AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5921
Mailing Address - Country:US
Mailing Address - Phone:801-616-6055
Mailing Address - Fax:
Practice Address - Street 1:520 E WHIDBEY AVE STE 208
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5921
Practice Address - Country:US
Practice Address - Phone:360-682-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9714122300000X
WADE611534821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist