Individual
BRUCE WM. THACKREY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1704 JEFFERSON AVE, MOUNT VERNON, IL 62864-4331
(618) 244-2440
(618) 244-0607
Mailing address
1704 JEFFERSON AVE, MOUNT VERNON, IL 62864-4331
(618) 244-2440
(618) 244-0607
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19A15719
IL
Other
Enumeration date
05/27/2006
Last updated
07/08/2007
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