Individual
DR. LEE W THACH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
186 ELM ST, EVERETT, MA 02149-5222
(617) 389-2112
(617) 389-5885
Mailing address
186 ELM ST, EVERETT, MA 02149-5222
(617) 389-2112
(617) 389-5885
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
19582
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0203220
—
MA
Enumeration date
03/11/2006
Last updated
07/09/2007
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