1336262179 NPI number — DR. ERNEST MARK THURBER DDS MSD

Table of content: DR. ERNEST MARK THURBER DDS MSD (NPI 1336262179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336262179 NPI number — DR. ERNEST MARK THURBER DDS MSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THURBER
Provider First Name:
ERNEST
Provider Middle Name:
MARK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS MSD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THURBER
Provider Other First Name:
MARK
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS MSD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336262179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 W DRY CREEK CIRCLE
Provider Second Line Business Mailing Address:
SUITE 540
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-798-6178
Provider Business Mailing Address Fax Number:
303-798-6006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 W DRY CREEK CIRCLE
Provider Second Line Business Practice Location Address:
SUITE 540
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-798-6178
Provider Business Practice Location Address Fax Number:
303-798-6006
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  105104 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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