Provider Demographics
NPI:1477674679
Name:THRONEBERRY, JAMES RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:THRONEBERRY
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 1:2506 DANVILLE RD SW
Mailing Address - Street 2:STE. 104
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4232
Mailing Address - Country:US
Mailing Address - Phone:256-353-3462
Mailing Address - Fax:256-353-6103
Practice Address - Street 1:2506 DANVILLE RD SW
Practice Address - Street 2:STE. 104
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4232
Practice Address - Country:US
Practice Address - Phone:256-353-3462
Practice Address - Fax:256-353-6103
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL96979OtherBCBS ID #