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215 S Fm 548 Suite C Forney TX 75126-4129 | |
| (469) 689-0704 | |
| (469) 689-0709 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 215 S Fm 548, Forney, Texas |
| Authorized Official Name and Position | Thomas K Draper (OWNER) |
| Authorized Official Contact | 4696890704 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
215 S Fm 548 Suite C Forney TX 75126-4129 Ph: (469) 689-0704 | 215 S Fm 548 Suite C Forney TX 75126-4129 Ph: (469) 689-0704 |
| NPI Number | 1700157146 |
|---|---|
| Provider Enumeration Date | 01/17/2012 |
| Last Update Date | 08/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700157146 | NPI | - | NPPES |
| 1306018320 | Other | TX | INDIVIDUAL NPI |
| 206992419 | Medicaid | TX | |
| 288152601 | Other | TX | FACILITY TPI MEDICAID |
| OPT0005 | Other | TX | MEDICARE OPT OUT PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 24789 (Texas) | Primary |
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