=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649990607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMANDA MCCAULEY THORNBERRY DMD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2022
-----------------------------------------------------
Last Update Date | 04/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 QUAIL DR
-----------------------------------------------------
City | CYNTHIANA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41031-9482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-987-7474
-----------------------------------------------------
Fax | 859-987-6060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1116 CURRENTSVILLE RD
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40361-8823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-588-1001
-----------------------------------------------------
Fax | 859-987-6050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AMANDA MCCAULEY THORNBERRY
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 859-588-1001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------