Provider Demographics
NPI:1336858174
Name:JOHN B DRAPER DMD PA
Entity Type:Organization
Organization Name:JOHN B DRAPER DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-325-6000
Mailing Address - Street 1:800 ZEAGLER DR STE 330
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3827
Mailing Address - Country:US
Mailing Address - Phone:386-325-6000
Mailing Address - Fax:386-325-9306
Practice Address - Street 1:800 ZEAGLER DR STE 330
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3827
Practice Address - Country:US
Practice Address - Phone:386-325-6000
Practice Address - Fax:386-325-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental