Provider Demographics
NPI:1568058162
Name:THORN, ELVA L (RDH)
Entity Type:Individual
Prefix:
First Name:ELVA
Middle Name:L
Last Name:THORN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ELVA
Other - Middle Name:L
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:12313 CRICKLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-6534
Mailing Address - Country:US
Mailing Address - Phone:813-995-1056
Mailing Address - Fax:
Practice Address - Street 1:12313 CRICKLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-6534
Practice Address - Country:US
Practice Address - Phone:813-995-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH14982124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist