Provider Demographics
NPI:1588357701
Name:THORNTON, BRIANNA RUSSELL (DMD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:RUSSELL
Last Name:THORNTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WESTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-6370
Mailing Address - Country:US
Mailing Address - Phone:207-400-7607
Mailing Address - Fax:
Practice Address - Street 1:495 WOODFORD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2438
Practice Address - Country:US
Practice Address - Phone:207-772-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN5057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist