MEDICARE: DR. LEANNE P THATCHER DDS LLC

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	261QD0000X	Dental Clinic/Center	019.024751	IL

General Provider Information

NPI Number	:	1740599547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. LEANNE P THATCHER DDS LLC

Provider Business Mailing Address
First Line	:	2917 17TH ST
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5382
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2917 17TH ST
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5382
Country	:	US
Telephone Number	:	309-788-3900
Fax Number	:	309-788-0971

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEANNE PATRICIA THATCHER
Credential	:	DDS
Telephone Number	:	309-788-3900

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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