Healthcare Provider Details

I. General information

NPI: 1609003466
Provider Name (Legal Business Name): ANDREW A THUERNAGLE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 EASTLAND DR
TWIN FALLS ID
83301-6858
US

IV. Provider business mailing address

794 EASTLAND DR
TWIN FALLS ID
83301-6856
US

V. Phone/Fax

Practice location:
  • Phone: 208-732-7447
  • Fax: 208-733-5940
Mailing address:
  • Phone: 208-732-7447
  • Fax: 208-733-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD4221
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: