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General NPI Number Information
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NPI Number | 1720576044
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Entity Type | Organization
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Legal Business Name | ELI THORNOCK DDS PLLC
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 299 MADISON AVE N STE A
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-1893
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Country | US
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Telephone | 206-842-4848
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Fax | 206-780-9646
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Provider Business Mailing Address
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Address Line | 299 MADISON AVE N STE A
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-1893
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Country | US
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Telephone | 206-842-4848
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Fax | 206-780-9646
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELI J THORNOCK
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Credential | DDS
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Telephone | 206-842-4848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE
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License Number State | WA
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