Provider Demographics
NPI:1467666925
Name:THORPE, EDGAR BLAIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:BLAIR
Last Name:THORPE
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 1:185 S 300 E
Mailing Address - Street 2:
Mailing Address - City:MALAD CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83252-1343
Mailing Address - Country:US
Mailing Address - Phone:208-766-2204
Mailing Address - Fax:
Practice Address - Street 1:185 S 300 E
Practice Address - Street 2:
Practice Address - City:MALAD CITY
Practice Address - State:ID
Practice Address - Zip Code:83252-1343
Practice Address - Country:US
Practice Address - Phone:208-766-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-18951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID69625OtherBLUE CROSS OF IDAHO
971248OtherUNITED CONCORDIA