Provider Demographics
NPI:1215790803
Name:DORIS K. THORNE, DDS, PA
Entity type:Organization
Organization Name:DORIS K. THORNE, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-937-7337
Mailing Address - Street 1:PO BOX 8467
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1467
Mailing Address - Country:US
Mailing Address - Phone:252-937-7337
Mailing Address - Fax:252-937-7232
Practice Address - Street 1:3729 WESTRIDGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3335
Practice Address - Country:US
Practice Address - Phone:252-937-7337
Practice Address - Fax:252-937-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275683542Medicaid
NC1942934385Medicaid