Provider Demographics
NPI:1033845219
Name:THACKER, KAPIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAPIL
Middle Name:
Last Name:THACKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 INDEX RD APT 104
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3217
Mailing Address - Country:US
Mailing Address - Phone:630-347-4752
Mailing Address - Fax:
Practice Address - Street 1:6301 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3415
Practice Address - Country:US
Practice Address - Phone:608-238-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2023-03-01
Deactivation Date:2023-02-20
Deactivation Code:
Reactivation Date:2023-03-01
Provider Licenses
StateLicense IDTaxonomies
WI6001046-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist