Provider Demographics
NPI:1417687054
Name:THARPE, DAKOTA JORDAN TYRUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAKOTA
Middle Name:JORDAN TYRUS
Last Name:THARPE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3947 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-7707
Mailing Address - Country:US
Mailing Address - Phone:478-217-6805
Mailing Address - Fax:
Practice Address - Street 1:1725 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3362
Practice Address - Country:US
Practice Address - Phone:229-883-7891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist