Provider Demographics
NPI:1366319493
Name:ROBERT R. THORUP, DDS, PC
Entity type:Organization
Organization Name:ROBERT R. THORUP, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:THORUP
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:310-801-9876
Mailing Address - Street 1:11193 S REDWOOD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8419
Mailing Address - Country:US
Mailing Address - Phone:801-944-9494
Mailing Address - Fax:801-944-9815
Practice Address - Street 1:11193 S REDWOOD RD STE 201
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8419
Practice Address - Country:US
Practice Address - Phone:801-944-9494
Practice Address - Fax:801-944-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty