MEDICARE: JENNIFER THORNE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21836	TX

General Provider Information

NPI Number	:	1275727901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER THORNE PA

Provider Business Mailing Address
First Line	:	6248 DAVIS BLVD
Second Line	:	SUITE 100
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7420
Country	:	US
Telephone Number	:	817-503-8000
Fax Number	:	817-503-8004

Provider Business Practice Location Address
First Line	:	6248 DAVIS BLVD
Second Line	:	SUITE 100
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7420
Country	:	US
Telephone Number	:	817-503-8000
Fax Number	:	817-503-8004

Authorized Official
Title or Position	:	PRESIDENT/DENTIST
Name	:	DR. JENNIFER RHEANNE THORNE
Credential	:	D.D.S.
Telephone Number	:	817-503-8000

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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