Provider Demographics
NPI:1376856534
Name:THORNTON, JEROMY L (DDS)
Entity Type:Individual
Prefix:
First Name:JEROMY
Middle Name:L
Last Name:THORNTON
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 1:7301 STATE HIGHWAY 161
Mailing Address - Street 2:SUITE 198
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2816
Mailing Address - Country:US
Mailing Address - Phone:972-869-3789
Mailing Address - Fax:972-869-3791
Practice Address - Street 1:3306 W CAMP WISDOM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2596
Practice Address - Country:US
Practice Address - Phone:972-709-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice