Provider Demographics
NPI:1437235678
Name:THORNE, JEFFREY BRUCE (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRUCE
Last Name:THORNE
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 1:43 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833
Mailing Address - Country:US
Mailing Address - Phone:908-236-2223
Mailing Address - Fax:908-236-7564
Practice Address - Street 1:43 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833
Practice Address - Country:US
Practice Address - Phone:908-236-2223
Practice Address - Fax:908-236-7564
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01526800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD115268OtherLICENSE REQUIRED FOR DELT
863738OtherPROVIDER ID REQUIRED FOR