Provider Demographics
NPI:1205047248
Name:DRAPER, MARY FORD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:FORD
Last Name:DRAPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1508 E SKYLINE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4846
Mailing Address - Country:US
Mailing Address - Phone:801-475-6500
Mailing Address - Fax:801-479-5904
Practice Address - Street 1:1508 E SKYLINE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4846
Practice Address - Country:US
Practice Address - Phone:801-475-6500
Practice Address - Fax:801-479-5904
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT276442-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice