Healthcare Provider Details

I. General information

NPI: 1053004408
Provider Name (Legal Business Name): MATTHEW H THORNHILL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 PROFESSIONAL DR
WEST MONROE LA
71291-5331
US

IV. Provider business mailing address

113 PROFESSIONAL DR
WEST MONROE LA
71291-5331
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-5423
  • Fax:
Mailing address:
  • Phone: 318-325-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW HUNTER THORNHILL
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 318-325-5423