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Individual
JENNIFER THACKERY
Active
Individual
JENNIFER THACKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DDS-09212
IA
Other
Enumeration date
06/17/2015
Last updated
12/22/2016
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