Provider Demographics
NPI:1407244189
Name:JACOBS AND THATCHER DENTISTRY, PLLC
Entity Type:Organization
Organization Name:JACOBS AND THATCHER DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-634-1932
Mailing Address - Street 1:1601 RICKENBACKER DR
Mailing Address - Street 2:SUITE #7
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5332
Mailing Address - Country:US
Mailing Address - Phone:813-634-1932
Mailing Address - Fax:813-634-8612
Practice Address - Street 1:1601 RICKENBACKER DR
Practice Address - Street 2:SUITE #7
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5332
Practice Address - Country:US
Practice Address - Phone:813-634-1932
Practice Address - Fax:813-634-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty