Provider Demographics
NPI:1285654830
Name:THOMPSON, SHUNDA (DDS)
Entity Type:Individual
Prefix:
First Name:SHUNDA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHUNDA
Other - Middle Name:
Other - Last Name:THOMPSON BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:12022 VIA PALAZZO LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7434
Mailing Address - Country:US
Mailing Address - Phone:713-775-2888
Mailing Address - Fax:281-359-5516
Practice Address - Street 1:3648 CYPRESS CREEK PKWY STE 246
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3617
Practice Address - Country:US
Practice Address - Phone:281-919-2983
Practice Address - Fax:281-359-5516
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23564122300000X, 1223G0001X, 1223X0400X
GADN0126491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186495115Medicaid
TX18649114Medicaid
GA836857158CMedicaid