Provider Demographics
NPI:1083971287
Name:THOMPSON, TRISTAN PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:PAUL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 BLAZER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2119
Mailing Address - Country:US
Mailing Address - Phone:859-543-0700
Mailing Address - Fax:
Practice Address - Street 1:3285 BLAZER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2119
Practice Address - Country:US
Practice Address - Phone:859-543-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist