Provider Demographics
NPI:1164790184
Name:LEE, THOMPSON GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMPSON
Middle Name:GEORGE
Last Name:LEE
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 1:373 S SCHMALE RD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2774
Mailing Address - Country:US
Mailing Address - Phone:630-668-9190
Mailing Address - Fax:
Practice Address - Street 1:373 S SCHMALE RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2774
Practice Address - Country:US
Practice Address - Phone:630-668-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0131601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice