Provider Demographics
NPI:1801116967
Name:MCCAULEY-THORNBERRY, AMANDA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIE
Last Name:MCCAULEY-THORNBERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BOURBON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2414
Mailing Address - Country:US
Mailing Address - Phone:859-588-1001
Mailing Address - Fax:859-987-7474
Practice Address - Street 1:109 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2134
Practice Address - Country:US
Practice Address - Phone:859-987-7474
Practice Address - Fax:859-987-7474
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8901122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice