Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DE60120018 | WA |
NPI | 1013233899 |
---|---|
Provider Name | Dr. Quinn J Draper |
First Address | Woodland, WA 98674-8482 |
Second Address | Woodland, WA 98674-8482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2010 |
Last Update Date | 26/09/2012 |