Provider Demographics
NPI:1295816593
Name:THOMPSON, DONALD WILLIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WILLIS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 CAHABA VALLEY DR
Mailing Address - Street 2:STE. A-1
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2668
Mailing Address - Country:US
Mailing Address - Phone:205-437-0777
Mailing Address - Fax:205-437-0888
Practice Address - Street 1:2224 CAHABA VALLEY DR
Practice Address - Street 2:STE. A-1
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2668
Practice Address - Country:US
Practice Address - Phone:205-437-0777
Practice Address - Fax:205-437-0888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL43351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics