Healthcare Provider Details

I. General information

NPI: 1467542472
Provider Name (Legal Business Name): THATCHER & BOUDREAU, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 COMPTON RD SUITE 20
CINCINNATI OH
45231-3826
US

IV. Provider business mailing address

800 COMPTON RD SUITE 20
CINCINNATI OH
45231-3826
US

V. Phone/Fax

Practice location:
  • Phone: 513-521-0110
  • Fax: 513-728-4093
Mailing address:
  • Phone: 513-521-0110
  • Fax: 513-728-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT L. THATCHER
Title or Position: OWNER
Credential: D.D.S.
Phone: 513-521-0110