Individual
DR. ANGELICA JANE BUSTOS THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
7603 GRAND TETON DR STE 140, LAS VEGAS, NV 89131-1602
(702) 957-1013
Mailing address
12028 HATHAWAY PINES LN, LAS VEGAS, NV 89138-4501
(702) 883-9376
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7617
NV
Other
Enumeration date
05/22/2022
Last updated
03/17/2023
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