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General NPI Number Information
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NPI Number | 1124507611
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Entity Type | Organization
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Legal Business Name | THORSON DENTISTRY FOR KIDS
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 159 LONGVIEW DR STE A
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City | DESTREHAN
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State | LA
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Zip | 70047
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Country | US
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Telephone | 985-307-0072
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Fax |
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Provider Business Mailing Address
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Address Line | 159 LONGVIEW DR STE A
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City | DESTREHAN
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State | LA
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Zip | 70047-5076
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Country | US
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Telephone | 985-307-0072
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOEY KEENER
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Credential |
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Telephone | 985-307-0072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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