Provider Demographics
NPI:1821073628
Name:THORN, BLAINE RANDY II (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:RANDY
Last Name:THORN
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2815 W LAKE HOUSTON PKWY
Mailing Address - Street 2:SUITE110
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5227
Mailing Address - Country:US
Mailing Address - Phone:281-360-5645
Mailing Address - Fax:281-360-8439
Practice Address - Street 1:2815 W LAKE HOUSTON PKWY
Practice Address - Street 2:SUITE110
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77339-5227
Practice Address - Country:US
Practice Address - Phone:281-360-5645
Practice Address - Fax:281-360-8439
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX120791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice