Provider Demographics
NPI:1093862476
Name:THOMSON, HARRY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:S
Last Name:THOMSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W WASHINGTON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2141
Mailing Address - Country:US
Mailing Address - Phone:517-787-9181
Mailing Address - Fax:517-768-9115
Practice Address - Street 1:306 W WASHINGTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2141
Practice Address - Country:US
Practice Address - Phone:517-787-9181
Practice Address - Fax:517-768-9115
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010101941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice