Healthcare Provider Details

I. General information

NPI: 1225100472
Provider Name (Legal Business Name): JAMES N THACKER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 NIMITZVIEW DR
CINCINNATI OH
45230-4359
US

IV. Provider business mailing address

1057 NIMITZVIEW DR
CINCINNATI OH
45230-4359
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-1600
  • Fax: 513-232-2389
Mailing address:
  • Phone: 513-232-1600
  • Fax: 513-232-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number17140
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9149
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: