Healthcare Provider Details

I. General information

NPI: 1164561031
Provider Name (Legal Business Name): THORNE DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PARTRIDGE DR SUITE 210
VENTURA CA
93003-5562
US

IV. Provider business mailing address

1001 PARTRIDGE DR SUITE 210
VENTURA CA
93003-5562
US

V. Phone/Fax

Practice location:
  • Phone: 805-644-9501
  • Fax: 805-644-1108
Mailing address:
  • Phone: 805-644-9501
  • Fax: 805-644-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number43868
License Number StateCA

VIII. Authorized Official

Name: MICHAEL J THORNE
Title or Position: PRESIDENT
Credential: DDS
Phone: 805-644-9501