Provider Demographics
NPI:1407165335
Name:THORNE DENT CORPORATION
Entity Type:Organization
Organization Name:THORNE DENT CORPORATION
Other - Org Name:MOORPARK SMILES DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-553-1980
Mailing Address - Street 1:144 W LOS ANGELES AVE
Mailing Address - Street 2:STE. 114
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1898
Mailing Address - Country:US
Mailing Address - Phone:805-553-1980
Mailing Address - Fax:805-553-1981
Practice Address - Street 1:144 W LOS ANGELES AVE
Practice Address - Street 2:STE. 114
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1898
Practice Address - Country:US
Practice Address - Phone:805-553-1980
Practice Address - Fax:805-553-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty