Provider Demographics
NPI:1265854921
Name:THOMPSON, TAMMY LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LYNNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 SOUTHWESTERN BLVD # D21
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4552
Mailing Address - Country:US
Mailing Address - Phone:570-204-5575
Mailing Address - Fax:
Practice Address - Street 1:1100 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2308
Practice Address - Country:US
Practice Address - Phone:716-650-7095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0557651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry