Provider Demographics
NPI:1942934351
Name:THORNE, MICHAELA RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:RAE
Last Name:THORNE
Suffix:
Gender:F
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:PO BOX 8467
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1467
Mailing Address - Country:US
Mailing Address - Phone:252-937-7337
Mailing Address - Fax:252-937-7232
Practice Address - Street 1:3729 WESTRIDGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3335
Practice Address - Country:US
Practice Address - Phone:252-937-7337
Practice Address - Fax:252-937-7232
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice