Provider Demographics
NPI:1255491320
Name:THORNE, JOANNE MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:MARIE
Last Name:THORNE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 NORTHERN BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9302
Mailing Address - Country:US
Mailing Address - Phone:570-585-8888
Mailing Address - Fax:570-585-8889
Practice Address - Street 1:239 NORTHERN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9302
Practice Address - Country:US
Practice Address - Phone:570-585-8888
Practice Address - Fax:570-585-8889
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030736L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017301920003Medicaid
PA986628OtherUNITED CONCORDIA
PA0017301920003Medicaid