Provider Demographics
NPI:1295828382
Name:THAKKER, DIPALI D (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIPALI
Middle Name:D
Last Name:THAKKER
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 1:3429 NAMEOKI RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3709
Mailing Address - Country:US
Mailing Address - Phone:618-452-2006
Mailing Address - Fax:618-452-2077
Practice Address - Street 1:3429 NAMEOKI RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3709
Practice Address - Country:US
Practice Address - Phone:618-452-2006
Practice Address - Fax:618-452-2077
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice