Provider Demographics
NPI:1205923943
Name:THORNTON, MALCOLM EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:EDWARD
Last Name:THORNTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 MARTIN'S WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2485
Mailing Address - Country:US
Mailing Address - Phone:281-491-8204
Mailing Address - Fax:281-491-8204
Practice Address - Street 1:FORT POLK DENTAC
Practice Address - Street 2:1585 3RD STREET, STE 6119A
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-531-4400
Practice Address - Fax:337-531-4715
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
TX184931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice