Provider Demographics
NPI:1912262957
Name:THATCHER, BRYAN RONALD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:RONALD
Last Name:THATCHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 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:813-323-7052
Mailing Address - Fax:
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:813-323-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist