Provider Demographics
NPI:1700157146
Name:THOMAS K. W. DRAPER, DMD. MD, PLLC
Entity Type:Organization
Organization Name:THOMAS K. W. DRAPER, DMD. MD, PLLC
Other - Org Name:TRINITY VALLEY ORAL SURGERY & DENTAL IMPLANT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-689-0704
Mailing Address - Street 1:215 S FM 548
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4129
Mailing Address - Country:US
Mailing Address - Phone:469-689-0704
Mailing Address - Fax:469-689-0709
Practice Address - Street 1:215 S FM 548
Practice Address - Street 2:SUITE C
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4129
Practice Address - Country:US
Practice Address - Phone:469-689-0704
Practice Address - Fax:469-689-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306018320OtherINDIVIDUAL NPI
TX206992419Medicaid
TX288152601OtherFACILITY TPI MEDICAID
TXOPT0005OtherMEDICARE OPT OUT PTAN