MEDICARE: MELANIE L THRONE DDS 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1861017584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELANIE L THRONE DDS PA

Provider Business Mailing Address
First Line	:	6417 SOUTHWEST BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-735-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6417 SOUTHWEST BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-735-4700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELANIE THRONE
Credential	:	DDS
Telephone Number	:	817-735-4700

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	06/09/2020

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