Ralph William Thacker Jr., D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5649 Issued in KY

Practice address

222 Main St.
Livermore, KY 42352-0490

Phone

(270) 278-2385

Fax

(270) 278-5111

NPI assigned

Oct 26, 2006

Last updated

Apr 24, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492992000000",
    "number": "1770668162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 MAIN ST.",
            "address_2": "P.O BOX 490",
            "city": "LIVERMORE",
            "state": "KY",
            "postal_code": "423520490",
            "telephone_number": "270-278-2385",
            "fax_number": "270-278-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 MAIN ST.",
            "city": "LIVERMORE",
            "state": "KY",
            "postal_code": "423520490",
            "telephone_number": "270-278-2385",
            "fax_number": "270-278-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "RALPH",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2017-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60056496",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany Nicole Brown, PHARMD
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• Pooles Pharmacy Care Inc (Pooles Pharmacy Care)

• General Practice Dentistry in Livermore, KY
• Providers in Livermore, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.