Provider Demographics
NPI:1417501362
Name:THORN, ANNA KARINA (DDS/MSD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:KARINA
Last Name:THORN
Suffix:
Gender:F
Credentials:DDS/MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 BROADWAY ST APT 1881
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7844
Mailing Address - Country:US
Mailing Address - Phone:281-779-5330
Mailing Address - Fax:
Practice Address - Street 1:1205 LAKE RD
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-5205
Practice Address - Country:US
Practice Address - Phone:409-938-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355671223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics