Provider Demographics
NPI:1922705326
Name:THRYVE DENTAL, PLLC
Entity Type:Organization
Organization Name:THRYVE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANEKA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-905-4905
Mailing Address - Street 1:4550 LAMAR AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-5129
Mailing Address - Country:US
Mailing Address - Phone:903-401-8017
Mailing Address - Fax:903-366-3416
Practice Address - Street 1:4550 LAMAR AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5129
Practice Address - Country:US
Practice Address - Phone:903-401-8017
Practice Address - Fax:903-366-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty