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General NPI Number Information
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NPI Number | 1912262957
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Entity Type | Individual
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Provider Name | BRYAN RONALD THATCHER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 1601 RICKENBACKER DR SUITE 7
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-5332
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Country | US
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Telephone | 813-323-7052
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 RICKENBACKER DR SUITE 7
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-5332
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Country | US
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Telephone | 813-323-7052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19759
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License Number State | FL
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