Provider Demographics
NPI:1740599547
Name:DR. LEANNE P THATCHER DDS LLC
Entity Type:Organization
Organization Name:DR. LEANNE P THATCHER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-788-3900
Mailing Address - Street 1:2917 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2917 17TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5382
Practice Address - Country:US
Practice Address - Phone:309-788-3900
Practice Address - Fax:309-788-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.024751261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental