Provider Demographics
NPI:1942397567
Name:THARP, RHETT WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RHETT
Middle Name:WAYNE
Last Name:THARP
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 1:3929 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5554
Mailing Address - Country:US
Mailing Address - Phone:812-339-7371
Mailing Address - Fax:812-332-5305
Practice Address - Street 1:3929 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5554
Practice Address - Country:US
Practice Address - Phone:812-339-7371
Practice Address - Fax:812-332-5305
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN81531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice