Provider Demographics
NPI:1497764070
Name:BRIAN L AND JENNIFER W THORNTON DDS PS
Entity Type:Organization
Organization Name:BRIAN L AND JENNIFER W THORNTON DDS PS
Other - Org Name:POULSBO DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:W
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-799-3633
Mailing Address - Street 1:19170 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8773
Mailing Address - Country:US
Mailing Address - Phone:360-779-3633
Mailing Address - Fax:360-779-6232
Practice Address - Street 1:19170 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8773
Practice Address - Country:US
Practice Address - Phone:360-779-3633
Practice Address - Fax:360-779-6232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA43641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty