Provider Demographics
NPI:1699316851
Name:THORNTON, LINDA JANE (DDS)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JANE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 OAK PL
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-8387
Mailing Address - Country:US
Mailing Address - Phone:609-471-8592
Mailing Address - Fax:
Practice Address - Street 1:101 LECOM WAY
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-6323
Practice Address - Country:US
Practice Address - Phone:850-951-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-028812-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist