Healthcare Provider Details

I. General information

NPI: 1316790157
Provider Name (Legal Business Name): LAYNE G THURSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SPRING STUEBNER RD
SPRING TX
77389-4812
US

IV. Provider business mailing address

7300 BROMPTON ST APT 4821
HOUSTON TX
77025-2167
US

V. Phone/Fax

Practice location:
  • Phone: 346-608-0698
  • Fax:
Mailing address:
  • Phone: 607-651-3874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41411
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: