MEDICARE: EDWARD D. THORNBLADE DDS

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	DS017018L	PA

General Provider Information

NPI Number	:	1518011956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD D. THORNBLADE DDS

Provider Business Mailing Address
First Line	:	513 WALNUT AVE
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1942
Country	:	US
Telephone Number	:	724-887-4111
Fax Number	:	724-887-5582

Provider Business Practice Location Address
First Line	:	322 PITTSBURGH ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1723
Country	:	US
Telephone Number	:	724-887-4111
Fax Number	:	724-887-5582

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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