Provider Demographics
NPI:1275678427
Name:THACKER, SUNNY M (DMD)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:M
Last Name:THACKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 SPURR RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-9124
Mailing Address - Country:US
Mailing Address - Phone:606-422-1208
Mailing Address - Fax:859-988-0310
Practice Address - Street 1:4223 LEXINGTON RD STE A
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2514
Practice Address - Country:US
Practice Address - Phone:859-988-0308
Practice Address - Fax:859-988-0310
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY84511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice