Provider Demographics
NPI:1639178957
Name:THATCHER, EDWARD MEAD (MS, DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MEAD
Last Name:THATCHER
Suffix:
Gender:M
Credentials:MS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E BROADWAY
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026641OtherODHS