Provider Demographics
NPI:1760645642
Name:THORSON, THOR G (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOR
Middle Name:G
Last Name:THORSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7949 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8602
Mailing Address - Country:US
Mailing Address - Phone:928-317-1900
Mailing Address - Fax:928-585-1025
Practice Address - Street 1:7949 E 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-8602
Practice Address - Country:US
Practice Address - Phone:928-317-1900
Practice Address - Fax:928-585-1025
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist