Provider Demographics
NPI:1356615165
Name:THORNOCK, ELI J (DDS)
Entity type:Individual
Prefix:DR
First Name:ELI
Middle Name:J
Last Name:THORNOCK
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 1:1050 GILLMORE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3305
Mailing Address - Country:US
Mailing Address - Phone:509-946-2258
Mailing Address - Fax:509-946-1211
Practice Address - Street 1:1050 GILLMORE AVE STE B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3305
Practice Address - Country:US
Practice Address - Phone:509-946-2258
Practice Address - Fax:509-946-1211
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602706221223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist