MEDICARE: SARAH THRUTCHLEY

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	126800000X	Dental Assistant	38966	TX

General Provider Information

NPI Number	:	1376053090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH THRUTCHLEY

Provider Business Mailing Address
First Line	:	11201 LYNBROOK DR APT 2802
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1358
Country	:	US
Telephone Number	:	832-212-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	11201 LYNBROOK DR APT 2802
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1358
Country	:	US
Telephone Number	:	832-212-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2017
Last Update Date	:	10/08/2017

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