MEDICARE: DR. MICHAEL THRASHER 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	1223G0001X	General Practice Dentistry	11864	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11864	OTHER	TX	LICENSE NUMBER

General Provider Information

NPI Number	:	1205988755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL THRASHER DDS

Provider Business Mailing Address
First Line	:	3500 HILLCREST DR STE 4
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3144
Country	:	US
Telephone Number	:	254-753-0313
Fax Number	:	254-753-0315

Provider Business Practice Location Address
First Line	:	3500 HILLCREST DR STE 4
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3144
Country	:	US
Telephone Number	:	254-753-0313
Fax Number	:	254-753-0315

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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