MEDICARE: DR. JAMES N THACKER D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	17140	OH
2	122300000X	Dentist	9149	KY

General Provider Information

NPI Number	:	1225100472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES N THACKER D.D.S.

Provider Business Mailing Address
First Line	:	1057 NIMITZVIEW DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4359
Country	:	US
Telephone Number	:	513-232-1600
Fax Number	:	513-232-2389

Provider Business Practice Location Address
First Line	:	1057 NIMITZVIEW DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4359
Country	:	US
Telephone Number	:	513-232-1600
Fax Number	:	513-232-2389

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	01/20/2015

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