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Individual

DANIEL J THACKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S,P.S.

Contact information

Practice address
26114 ILLINOIS AVENUE, SUITE A, KINGSTON, WA 98346-0149
(360) 297-3392
(360) 297-4331
Mailing address
PO BOX 149, 26114 ILLINOIS AVE, KINGSTON, WA 98346-0149
(360) 297-3392
(360) 297-4331

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00005967
WA

Other

Enumeration date
04/23/2007
Last updated
07/08/2007
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