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General NPI Number Information
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NPI Number | 1316790157
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Entity Type | Individual
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Provider Name | LAYNE G THURSTON
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Gender | Male
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 06/22/2025
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Provider Practice Location Address
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Address Line | 5106 FAIRMONT PKWY
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City | PASADENA
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State | TX
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Zip | 77505-3728
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Country | US
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Telephone | 607-651-3874
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 BROMPTON ST APT 4821
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City | HOUSTON
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State | TX
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Zip | 77025-2167
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Country | US
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Telephone | 607-651-3874
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 41411
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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