Provider Demographics
NPI:1952476285
Name:THRESHER, ALFRED ADDISON III (DDS)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:ADDISON
Last Name:THRESHER
Suffix:III
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 1:9500 W FLAMINGO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-5720
Mailing Address - Country:US
Mailing Address - Phone:702-254-4335
Mailing Address - Fax:702-254-7995
Practice Address - Street 1:9500 W FLAMINGO RD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-5720
Practice Address - Country:US
Practice Address - Phone:702-254-4335
Practice Address - Fax:702-254-7995
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511177Medicaid