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General NPI Number Information
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NPI Number | 1376856534
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Entity Type | Individual
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Provider Name | JEROMY L THORNTON DDS
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Gender | Male
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 3306 W CAMP WISDOM RD SUITE 100
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City | DALLAS
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State | TX
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Zip | 75237-2596
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Country | US
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Telephone | 972-709-4867
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 STATE HIGHWAY 161 SUITE 198
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City | IRVING
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State | TX
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Zip | 75039-2816
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Country | US
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Telephone | 972-869-3789
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Fax | 972-869-3791
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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 | 25808
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License Number State | TX
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