Provider Demographics
NPI:1528511078
Name:THORNYDALE DENTAL CARE LLC
Entity type:Organization
Organization Name:THORNYDALE DENTAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-744-5150
Mailing Address - Street 1:8300 N THORNYDALE RD
Mailing Address - Street 2:STE 116
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1167
Mailing Address - Country:US
Mailing Address - Phone:520-744-5158
Mailing Address - Fax:520-744-5322
Practice Address - Street 1:8300 N THORNYDALE RD
Practice Address - Street 2:STE 116
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-1167
Practice Address - Country:US
Practice Address - Phone:520-744-5158
Practice Address - Fax:520-744-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ5200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty