Provider Demographics
NPI:1093880593
Name:THOR, ALEX MA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:MA
Last Name:THOR
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 1:3120 EDMONTON DR
Mailing Address - Street 2:SUITE #400
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4593
Mailing Address - Country:US
Mailing Address - Phone:608-837-3949
Mailing Address - Fax:
Practice Address - Street 1:3120 EDMONTON DR
Practice Address - Street 2:SUITE #400
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-4593
Practice Address - Country:US
Practice Address - Phone:608-837-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5630-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist