Provider Demographics
NPI:1659541555
Name:THAKER, DURGESH D (BDS)
Entity Type:Individual
Prefix:DR
First Name:DURGESH
Middle Name:D
Last Name:THAKER
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5473 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2954
Mailing Address - Country:US
Mailing Address - Phone:954-486-7025
Mailing Address - Fax:954-485-2209
Practice Address - Street 1:5473 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2954
Practice Address - Country:US
Practice Address - Phone:954-486-7025
Practice Address - Fax:954-485-2209
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist