Provider Demographics
NPI:1841301314
Name:DRAPER, VIVIAN (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:DRAPER
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2827
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-2827
Mailing Address - Country:US
Mailing Address - Phone:662-840-0584
Mailing Address - Fax:
Practice Address - Street 1:60024 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MS
Practice Address - Zip Code:38870-9719
Practice Address - Country:US
Practice Address - Phone:662-651-7111
Practice Address - Fax:662-651-7115
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3166-00122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660401Medicaid