Healthcare Provider Details

I. General information

NPI: 1124111406
Provider Name (Legal Business Name): SCOTT ALLAN DRAPER D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 KELLY JOHNSON BLVD SUITE 210
COLORADO SPRINGS CO
80920-3932
US

IV. Provider business mailing address

3527 OAK MEADOW DR
COLORADO SPRINGS CO
80920-2404
US

V. Phone/Fax

Practice location:
  • Phone: 719-532-1007
  • Fax: 719-532-0048
Mailing address:
  • Phone: 719-264-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number8698
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: