Healthcare Provider Details

I. General information

NPI: 1538374269
Provider Name (Legal Business Name): WAYNE G. THORPE, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3329 E BASELINE RD
GILBERT AZ
85234-2633
US

IV. Provider business mailing address

3329 E BASELINE RD
GILBERT AZ
85234-2633
US

V. Phone/Fax

Practice location:
  • Phone: 480-539-6420
  • Fax: 480-558-0176
Mailing address:
  • Phone: 480-539-6420
  • Fax: 480-558-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number1819
License Number StateAZ

VIII. Authorized Official

Name: JEANNE THORPE
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-539-6420