=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477668721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THORNTON A D ARC DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 LAGUNA ROAD SUITE 200
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-879-5960
-----------------------------------------------------
Fax | 714-879-8470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 LAGUNA ROAD SUITE 200
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-879-5960
-----------------------------------------------------
Fax | 714-879-8470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | THORNTON ARTHUR D ARC
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 714-879-5960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 23293
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------