Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22347 | TX |
NPI | 1003915349 |
---|---|
Provider Name | Dr. Richard Glenn Thorpe |
First Address | Southlake, TX 76092 |
Second Address | Southlake, TX 76092 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |