Provider Demographics
NPI:1578639720
Name:THORNE, GARY ALAN (DDS)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALAN
Last Name:THORNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 EARL GARRET
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3325
Mailing Address - Country:US
Mailing Address - Phone:830-896-1700
Mailing Address - Fax:830-257-2965
Practice Address - Street 1:702 EARL GARRET
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3325
Practice Address - Country:US
Practice Address - Phone:830-896-1700
Practice Address - Fax:830-257-2965
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice