MEDICARE: DR. KATRINA ANNE THATCH 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	0442000296	VA
2	122300000X	Dentist	0401416005	VA

General Provider Information

NPI Number	:	1992226484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATRINA ANNE THATCH DDS

Provider Business Mailing Address
First Line	:	2244 MILLCREST TER
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-4397
Country	:	US
Telephone Number	:	704-315-7859
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 BOULEVARD STE A
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1329
Country	:	US
Telephone Number	:	804-526-0937
Fax Number	:

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

Provider Enumeration Date	:	07/05/2017
Last Update Date	:	03/08/2022

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