Provider Demographics
NPI:1144652868
Name:THURSTON, FREDERICK D (DMD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:D
Last Name:THURSTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3411
Mailing Address - Country:US
Mailing Address - Phone:863-967-7548
Mailing Address - Fax:
Practice Address - Street 1:308 E PARK ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3411
Practice Address - Country:US
Practice Address - Phone:863-967-7548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist