Provider Demographics
NPI:1407644156
Name:THORNBERRY, EMILY MARIE (DMD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:THORNBERRY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:
Mailing Address - City:MARTHASVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63357-1166
Mailing Address - Country:US
Mailing Address - Phone:217-220-2623
Mailing Address - Fax:
Practice Address - Street 1:1111 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3308
Practice Address - Country:US
Practice Address - Phone:217-220-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program