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Individual
EDWIN R THORP
Active
Individual
EDWIN R THORP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00004724
WA
1223G0001X
General Practice Dentistry
DE00004724
WA
1223P0700X
Prosthodontics
4724
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616TH
REGENCE
WA
01
—
5308
WDS
WA
Enumeration date
06/14/2005
Last updated
10/26/2009
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