Provider Demographics
NPI:1154487221
Name:THOMPSON, ELIZABETH A (RDH)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2773 B 1/2 RD
Mailing Address - Street 2:STE A
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-3036
Mailing Address - Country:US
Mailing Address - Phone:970-257-1103
Mailing Address - Fax:970-257-7522
Practice Address - Street 1:2773 B 1/2 RD
Practice Address - Street 2:STE A
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-3036
Practice Address - Country:US
Practice Address - Phone:970-257-1103
Practice Address - Fax:970-257-7522
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO200415124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist