Provider Demographics
NPI:1407936156
Name:THORNTON, HEATHER C (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:C
Last Name:THORNTON
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 1:7015 HALCYON PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7763
Mailing Address - Country:US
Mailing Address - Phone:334-284-1100
Mailing Address - Fax:334-281-1245
Practice Address - Street 1:7015 HALCYON PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7763
Practice Address - Country:US
Practice Address - Phone:334-284-1100
Practice Address - Fax:334-281-1245
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL47691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051515540OtherBCBS
AL529914960Medicaid