Individual
LAUREN THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
4301 ORCHARD LAKE RD, SUITE 180-184, WEST BLOOMFIELD, MI 48323-1604
(888) 629-7773
Mailing address
5072 CUTTY LN, WARREN, MI 48092-6324
(586) 214-1991
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902017535
MI
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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