Provider Demographics
NPI:1427121813
Name:THORSON, CRAIG THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:THOMAS
Last Name:THORSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 WEALTHY ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3056
Mailing Address - Country:US
Mailing Address - Phone:616-458-8901
Mailing Address - Fax:616-458-8902
Practice Address - Street 1:2140 WEALTHY ST SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3032
Practice Address - Country:US
Practice Address - Phone:616-458-8901
Practice Address - Fax:616-458-8902
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010158901223G0001X
MI158901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice