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General NPI Number Information
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NPI Number | 1669636189
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Entity Type | Organization
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Legal Business Name | THG DENTAL, PLLC
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 12090 N. THORNYDALE, STE 106
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City | MARANA
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State | AZ
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Zip | 85658-4779
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Country | US
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Telephone | 520-616-4610
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Fax | 520-616-4609
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Provider Business Mailing Address
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Address Line | 12090 N. THORNYDALE, STE 106
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City | MARANA
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State | AZ
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Zip | 85658-4779
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Country | US
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Telephone | 520-616-4610
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Fax | 520-616-4609
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRYM H GIBBONS
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Credential | DDS
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Telephone | 520-616-4610
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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 | 6566
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License Number State | AZ
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