Provider Demographics
NPI:1316942691
Name:THORP, EDWIN R (DDS, MSD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:R
Last Name:THORP
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 MERIDIAN ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1735
Mailing Address - Country:US
Mailing Address - Phone:360-733-2303
Mailing Address - Fax:360-676-9414
Practice Address - Street 1:3628 MERIDIAN ST
Practice Address - Street 2:STE 1A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1735
Practice Address - Country:US
Practice Address - Phone:360-733-2303
Practice Address - Fax:360-676-9414
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2009-10-26
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
WA47241223P0700X
WADE00004724122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1616THOtherREGENCE
WA5308OtherWDS
WA5308OtherWDS