Provider Demographics
NPI:1467543884
Name:THOR, DONALD A (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:THOR
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 1:1875 E VALLEY PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2532
Mailing Address - Country:US
Mailing Address - Phone:760-746-5610
Mailing Address - Fax:760-746-5775
Practice Address - Street 1:1875 E VALLEY PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2532
Practice Address - Country:US
Practice Address - Phone:760-746-5610
Practice Address - Fax:760-746-5775
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice