MEDICARE: DR. SANDRA KAYE THORE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5927	NC

General Provider Information

NPI Number	:	1780890525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA KAYE THORE D.M.D.

Provider Business Mailing Address
First Line	:	3808 CITY OF OAKS WYND
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5305
Country	:	US
Telephone Number	:	919-607-0767
Fax Number	:	919-881-0949

Provider Business Practice Location Address
First Line	:	3808 CITY OF OAKS WYND
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5305
Country	:	US
Telephone Number	:	919-607-0767
Fax Number	:	919-881-0949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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