Provider Demographics
NPI:1053450213
Name:MICHAEL J. THORNE D.D.S. INC
Entity Type:Organization
Organization Name:MICHAEL J. THORNE D.D.S. INC
Other - Org Name:MISSION DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-648-1090
Mailing Address - Street 1:26 S GARDEN ST
Mailing Address - Street 2:SUITE I & J
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4521
Mailing Address - Country:US
Mailing Address - Phone:805-648-1090
Mailing Address - Fax:805-641-9130
Practice Address - Street 1:26 S GARDEN ST
Practice Address - Street 2:SUITE I & J
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-4521
Practice Address - Country:US
Practice Address - Phone:805-648-1090
Practice Address - Fax:805-641-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty