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General NPI Number Information
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NPI Number | 1356615165
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Entity Type | Individual
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Provider Name | ELI J THORNOCK DDS
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Gender | Male
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 1050 GILLMORE AVE STE B
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City | RICHLAND
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State | WA
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Zip | 99352-3305
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Country | US
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Telephone | 509-946-2258
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Fax | 509-946-1211
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Provider Business Mailing Address
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Address Line | 1050 GILLMORE AVE STE B
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City | RICHLAND
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State | WA
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Zip | 99352-3305
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Country | US
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Telephone | 509-946-2258
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Fax | 509-946-1211
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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 | DE60270622
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60270622
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License Number State | WA
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