MEDICARE: DR. LEANNE PATRICIA THATCHER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019024751	IL

General Provider Information

NPI Number	:	1205941549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEANNE PATRICIA THATCHER DDS

Provider Business Mailing Address
First Line	:	2917 17TH STREET
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201
Country	:	US
Telephone Number	:	309-788-3900
Fax Number	:	309-788-0971

Provider Business Practice Location Address
First Line	:	2917 17TH STREET
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201
Country	:	US
Telephone Number	:	309-788-3900
Fax Number	:	309-788-0971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/27/2012

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