Provider Demographics
NPI:1255567020
Name:DRAYER, PENELOPE RASEKH (DDS)
Entity type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:RASEKH
Last Name:DRAYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PENELOPE
Other - Middle Name:SHAIDA
Other - Last Name:RASEKH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5934 WEST PARKER ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-781-1617
Mailing Address - Fax:972-867-5900
Practice Address - Street 1:5934 WEST PARKER ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-781-1617
Practice Address - Fax:972-867-5900
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice