Provider Demographics
NPI:1740432715
Name:THIO, JERLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERLY
Middle Name:
Last Name:THIO
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 1:15308 VIRGIL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3668
Mailing Address - Country:US
Mailing Address - Phone:310-989-8911
Mailing Address - Fax:
Practice Address - Street 1:15308 VIRGIL AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3668
Practice Address - Country:US
Practice Address - Phone:310-989-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist