Provider Demographics
NPI:1184716029
Name:DRAUDE, JEFFREY A (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:DRAUDE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MCHUGH BLVD
Mailing Address - Street 2:2 D DENBN/NDC
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2511
Mailing Address - Country:US
Mailing Address - Phone:910-451-2208
Mailing Address - Fax:910-451-8036
Practice Address - Street 1:315 MCHUGH BLVD
Practice Address - Street 2:2 D DENBN/NDC
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2511
Practice Address - Country:US
Practice Address - Phone:910-451-2208
Practice Address - Fax:910-451-8036
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist