Provider Demographics
NPI:1033848593
Name:THOMPSON & GRAY, DDS, PA
Entity Type:Organization
Organization Name:THOMPSON & GRAY, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-335-4341
Mailing Address - Street 1:905 HALSTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6986
Mailing Address - Country:US
Mailing Address - Phone:252-335-4341
Mailing Address - Fax:
Practice Address - Street 1:905 HALSTEAD BLVD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6986
Practice Address - Country:US
Practice Address - Phone:252-335-4341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1710437322OtherGENERAL DENTIST