Provider Demographics
NPI:1164149472
Name:THOMPSON, JESSICA A (RDH)
Entity Type:Individual
Prefix:
First Name:JESSICA
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 1:2235 NE CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8068
Mailing Address - Country:US
Mailing Address - Phone:206-347-0949
Mailing Address - Fax:206-745-3811
Practice Address - Street 1:2235 NE CASTLE DR
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8068
Practice Address - Country:US
Practice Address - Phone:206-347-0949
Practice Address - Fax:206-745-3811
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60420420124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty