MEDICARE: DR. CHARLES MATTHEW THORNE D.D.S.

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	122300000X	Dentist	22031	TX

General Provider Information

NPI Number	:	1841411196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MATTHEW THORNE D.D.S.

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

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/22/2024

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