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General NPI Number Information
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NPI Number | 1598588451
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Entity Type | Organization
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Legal Business Name | THADDOUS ARCHIE, DDS
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 8013 LAGUNA BLVD STE 2
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City | ELK GROVE
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State | CA
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Zip | 95758-8130
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Country | US
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Telephone | 916-691-6020
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Fax | 916-691-6022
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Provider Business Mailing Address
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Address Line | 8013 LAGUNA BLVD STE 2
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City | ELK GROVE
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State | CA
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Zip | 95758-8130
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Country | US
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Telephone | 916-691-6020
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Fax | 916-691-6022
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Authorized Official
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Title or Position | DENTIST, OWNER
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Name | DR. THADDOUS L ARCHIE
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Credential | DDS
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Telephone | 916-691-6020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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