Healthcare Provider Details

I. General information

NPI: 1316942691
Provider Name (Legal Business Name): EDWIN R THORP DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/23/2006

III. Provider practice location address

3628 MERIDIAN ST STE 1A
BELLINGHAM WA
98225-1735
US

IV. Provider business mailing address

3628 MERIDIAN ST STE 1A
BELLINGHAM WA
98225-1735
US

V. Phone/Fax

Practice location:
  • Phone: 360-733-2303
  • Fax: 360-676-9414
Mailing address:
  • Phone: 360-733-2303
  • Fax: 360-676-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4724
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00004724
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00004724
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: