Provider Demographics
NPI:1053673939
Name:THOMPSON, COURTNEY (DDS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 JONES FERRY RD
Mailing Address - Street 2:APARTMENT VV07
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:605 JONES FERRY RD
Practice Address - Street 2:APARTMENT VV07
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2106
Practice Address - Country:US
Practice Address - Phone:919-946-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice