Provider Demographics
NPI:1780316349
Name:THORPE, CHASE J (DMD)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:J
Last Name:THORPE
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 1:9977 N WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3469
Mailing Address - Country:US
Mailing Address - Phone:801-376-2917
Mailing Address - Fax:
Practice Address - Street 1:710 23RD ST UNIT 300
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4654
Practice Address - Country:US
Practice Address - Phone:806-421-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386931223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice