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General NPI Number Information
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NPI Number | 1457444143
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Entity Type | Individual
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Provider Name | ROGER R THRONDSON DDS
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 301 UNIVERSITY BLVD
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City | GALVESTON
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State | TX
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Zip | 77555-5302
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Country | US
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Telephone | 409-772-0817
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Fax | 409-772-0885
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Provider Business Mailing Address
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Address Line | 301 UNIVERSITY BLVD
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City | GALVESTON
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State | TX
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Zip | 77555-5302
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Country | US
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Telephone | 409-747-0890
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Fax | 409-772-0885
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 17375
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License Number State | TX
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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 | 17375
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License Number State | TX
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