Provider Demographics
NPI:1447497524
Name:DRAPER, JONATHAN R (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:DRAPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2834
Mailing Address - Country:US
Mailing Address - Phone:949-248-5555
Mailing Address - Fax:
Practice Address - Street 1:629 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2834
Practice Address - Country:US
Practice Address - Phone:949-248-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice