Provider Demographics
NPI:1699198671
Name:THORSBY DENTAL CLINIC
Entity Type:Organization
Organization Name:THORSBY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUD
Authorized Official - Middle Name:GRIFFIN
Authorized Official - Last Name:HORNSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-646-3507
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:THORSBY
Mailing Address - State:AL
Mailing Address - Zip Code:35171-0607
Mailing Address - Country:US
Mailing Address - Phone:205-646-3507
Mailing Address - Fax:205-646-0401
Practice Address - Street 1:12 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:THORSBY
Practice Address - State:AL
Practice Address - Zip Code:35171
Practice Address - Country:US
Practice Address - Phone:205-646-3507
Practice Address - Fax:205-646-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL59441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty