Healthcare Provider Details

I. General information

NPI: 1841301314
Provider Name (Legal Business Name): VIVIAN DRAPER D.D.S., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60024 OLIVE ST
SMITHVILLE MS
38870-9719
US

IV. Provider business mailing address

PO BOX 2827
TUPELO MS
38803-2827
US

V. Phone/Fax

Practice location:
  • Phone: 662-651-7111
  • Fax: 662-651-7115
Mailing address:
  • Phone: 662-840-0584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3166-00
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: