Healthcare Provider Details

I. General information

NPI: 1407244189
Provider Name (Legal Business Name): JACOBS AND THATCHER DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 RICKENBACKER DR SUITE #7
SUN CITY CENTER FL
33573-5332
US

IV. Provider business mailing address

1601 RICKENBACKER DR SUITE #7
SUN CITY CENTER FL
33573-5332
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-1932
  • Fax: 813-634-8612
Mailing address:
  • Phone: 813-634-1932
  • Fax: 813-634-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN R. THATCHER
Title or Position: MANAGING MEMBER
Credential: D.M.D.
Phone: 813-634-1932