Provider Demographics
NPI:1275602278
Name:THURBER, ANGELA M (RDH)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:THURBER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16215 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7723
Mailing Address - Country:US
Mailing Address - Phone:480-704-1506
Mailing Address - Fax:
Practice Address - Street 1:4910 E. CHANDLER RD.
Practice Address - Street 2:120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044
Practice Address - Country:US
Practice Address - Phone:480-785-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4790124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty