Individual provider Active NPI

Dennis Anthony Thornley, D.D.S.

  • General Practice Dentistry
  • Grand Haven, MI
National Provider Identifier
1376603423
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
016542 Issued in MI
Practice address
17000 Robbins Rd
Grand Haven, MI 49417-2788
Phone
(616) 846-7360
NPI assigned
Dec 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 016542 MI Primary

Addresses

Primary practice location

17000 Robbins Rd
Grand Haven, MI 49417-2788

Mailing address

17000 Robbins Rd
Grand Haven, MI 49417-2788
Phone (616) 846-7360

Other identifiers 1

IdentifierTypeStateIssuer
4164057MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150507000650 MI Order and Referring Only - DentistPractitioner - Dentist 6901125327

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016542MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Thornley and Associates DDS PC Past Accepting new patients
Bethany Christian Services Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376603423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 ROBBINS RD",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172788",
            "telephone_number": "616-846-7360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17000 ROBBINS RD",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172788",
            "telephone_number": "616-846-7360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORNLEY",
        "first_name": "DENNIS",
        "middle_name": "ANTHONY",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "016542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4164057",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Haven, MI

Sources for this page

Verify at the official NPI Registry.