Provider Demographics
NPI:1457912263
Name:DRAPER, JOHN BRANDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRANDON
Last Name:DRAPER
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 1:2303 SHIPWRECK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1119
Mailing Address - Country:US
Mailing Address - Phone:904-219-0035
Mailing Address - Fax:
Practice Address - Street 1:5218 JAMMES RD STE D
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7740
Practice Address - Country:US
Practice Address - Phone:904-778-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL243101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty