Provider Demographics
NPI:1629214697
Name:THORNLEY, LOUIS JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:JAMES
Last Name:THORNLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:THORNLEY
Other - Middle Name:
Other - Last Name:DENTAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:515 7TH AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4933
Mailing Address - Country:US
Mailing Address - Phone:907-456-8100
Mailing Address - Fax:907-456-8101
Practice Address - Street 1:515 7TH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4933
Practice Address - Country:US
Practice Address - Phone:907-456-8100
Practice Address - Fax:907-456-8101
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD97101Medicaid