Provider Demographics
NPI:1417966284
Name:THORNBROUGH, ROY LEAFORD (DDS)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:LEAFORD
Last Name:THORNBROUGH
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:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-0445
Mailing Address - Country:US
Mailing Address - Phone:580-928-5581
Mailing Address - Fax:
Practice Address - Street 1:1605 NORTH WATTS STREET
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662
Practice Address - Country:US
Practice Address - Phone:580-928-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice