Provider Demographics
NPI:1578133690
Name:THORNTON, KEAIRA (DMD)
Entity Type:Individual
Prefix:
First Name:KEAIRA
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6539
Mailing Address - Country:US
Mailing Address - Phone:804-780-0840
Mailing Address - Fax:
Practice Address - Street 1:719 N 25TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6539
Practice Address - Country:US
Practice Address - Phone:804-780-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014175391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice