Provider Demographics
NPI:1255784690
Name:THORBURN, MEGHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:
Last Name:THORBURN
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 1:1124 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4313
Mailing Address - Country:US
Mailing Address - Phone:817-332-9393
Mailing Address - Fax:
Practice Address - Street 1:1124 S LAKE ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4313
Practice Address - Country:US
Practice Address - Phone:817-332-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32025122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist