Provider Demographics
NPI:1255690699
Name:EDWARD M. THATCHER
Entity Type:Organization
Organization Name:EDWARD M. THATCHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DMD
Authorized Official - Phone:541-686-8326
Mailing Address - Street 1:132 E BROADWAY
Mailing Address - Street 2:STE. 629
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3143
Mailing Address - Country:US
Mailing Address - Phone:541-686-8326
Mailing Address - Fax:541-345-0933
Practice Address - Street 1:132 E BROADWAY
Practice Address - Street 2:STE. 629
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3143
Practice Address - Country:US
Practice Address - Phone:541-686-8326
Practice Address - Fax:541-345-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty