Provider Demographics
NPI:1497887608
Name:THORNE, EDWARD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
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 1:8502 QUAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4245
Mailing Address - Country:US
Mailing Address - Phone:806-797-1827
Mailing Address - Fax:806-791-2596
Practice Address - Street 1:8502 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4245
Practice Address - Country:US
Practice Address - Phone:806-797-1827
Practice Address - Fax:806-791-2596
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice