Provider Demographics
NPI:1275727901
Name:JENNIFER THORNE PA
Entity type:Organization
Organization Name:JENNIFER THORNE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RHEANNE
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-503-8000
Mailing Address - Street 1:6248 DAVIS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7420
Mailing Address - Country:US
Mailing Address - Phone:817-503-8000
Mailing Address - Fax:817-503-8004
Practice Address - Street 1:6248 DAVIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7420
Practice Address - Country:US
Practice Address - Phone:817-503-8000
Practice Address - Fax:817-503-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty