MEDICARE: DR. DURGESH D. THAKER B.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	122300000X	Dentist	9492	FL

General Provider Information

NPI Number	:	1659541555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DURGESH D. THAKER B.D.S.

Provider Business Mailing Address
First Line	:	5473 N STATE ROAD 7
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2954
Country	:	US
Telephone Number	:	954-486-7025
Fax Number	:	954-485-2209

Provider Business Practice Location Address
First Line	:	5473 N STATE ROAD 7
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2954
Country	:	US
Telephone Number	:	954-486-7025
Fax Number	:	954-485-2209

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

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	03/06/2008

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Directions to “ DR. DURGESH D. THAKER B.D.S.” Practice Location

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