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General NPI Number Information
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NPI Number | 1740599547
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Entity Type | Organization
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Legal Business Name | DR. LEANNE P THATCHER DDS LLC
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 2917 17TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-5382
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Country | US
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Telephone | 309-788-3900
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Fax | 309-788-0971
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Provider Business Mailing Address
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Address Line | 2917 17TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-5382
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEANNE PATRICIA THATCHER
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Credential | DDS
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Telephone | 309-788-3900
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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 | 019.024751
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License Number State | IL
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