Provider Demographics
NPI:1164561031
Name:THORNE DENTAL CORPORATION
Entity Type:Organization
Organization Name:THORNE DENTAL CORPORATION
Other - Org Name:VENTURA 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:805-644-9501
Mailing Address - Street 1:1001 PARTRIDGE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5562
Mailing Address - Country:US
Mailing Address - Phone:805-644-9501
Mailing Address - Fax:805-644-1108
Practice Address - Street 1:1001 PARTRIDGE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5562
Practice Address - Country:US
Practice Address - Phone:805-644-9501
Practice Address - Fax:805-644-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
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