Provider Demographics
NPI:1003915349
Name:THORPE, RICHARD GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GLENN
Last Name:THORPE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 E HWY 114
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-488-3000
Mailing Address - Fax:817-488-3017
Practice Address - Street 1:1940 E HWY 114
Practice Address - Street 2:SUITE #100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-488-3000
Practice Address - Fax:817-488-3017
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist