Provider Demographics
NPI:1093996639
Name:THORNYDALE DENTAL, P.C.
Entity Type:Organization
Organization Name:THORNYDALE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RADD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-744-5150
Mailing Address - Street 1:8300 N THORNYDALE RD
Mailing Address - Street 2:SUITE #116
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1167
Mailing Address - Country:US
Mailing Address - Phone:520-744-5150
Mailing Address - Fax:520-744-5322
Practice Address - Street 1:8300 N THORNYDALE RD
Practice Address - Street 2:SUITE #116
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-1167
Practice Address - Country:US
Practice Address - Phone:520-744-5150
Practice Address - Fax:520-744-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty