Provider Demographics
NPI:1740382464
Name:THRAN, J DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:DOUGLAS
Last Name:THRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 OAKFORD RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9244
Mailing Address - Country:US
Mailing Address - Phone:570-586-5003
Mailing Address - Fax:570-585-7935
Practice Address - Street 1:203 OAKFORD RD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9244
Practice Address - Country:US
Practice Address - Phone:570-586-5003
Practice Address - Fax:570-585-7935
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024552-L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics