Provider Demographics
NPI:1922511641
Name:DRAPER, SAMANTHA JEAN (RDH)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEAN
Last Name:DRAPER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:JEAN
Other - Last Name:DRAPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:6401 S RICHARDS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-4887
Mailing Address - Country:US
Mailing Address - Phone:505-984-5048
Mailing Address - Fax:
Practice Address - Street 1:6401 S RICHARDS AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-4887
Practice Address - Country:US
Practice Address - Phone:505-984-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH4385124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist