Provider Demographics
NPI:1902943020
Name:THUNEN, PHILIP ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ROSS
Last Name:THUNEN
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 1:443 DEL NORTE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4113
Mailing Address - Country:US
Mailing Address - Phone:530-671-2860
Mailing Address - Fax:530-671-0441
Practice Address - Street 1:443 DEL NORTE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4113
Practice Address - Country:US
Practice Address - Phone:530-671-2860
Practice Address - Fax:530-671-0441
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA186531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice