Provider Demographics
NPI:1104988146
Name:THOREN, JAMES MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:THOREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E. 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98421
Mailing Address - Country:US
Mailing Address - Phone:253-722-1540
Mailing Address - Fax:253-722-1546
Practice Address - Street 1:10510 GRAVELLY LAKE DRIVE
Practice Address - Street 2:COMMUNITY HEALTH CARE - LAKEWOOD DENTAL
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-589-7188
Practice Address - Fax:253-284-4384
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA73831223G0001X
WADE 000073831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice