Provider Demographics
NPI:1326223058
Name:THOMSEN, DOROTHY A (DDS)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:THOMSEN
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 1:909 E OAK ST STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5840
Mailing Address - Country:US
Mailing Address - Phone:407-847-2103
Mailing Address - Fax:407-847-5042
Practice Address - Street 1:909 E OAK ST STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5840
Practice Address - Country:US
Practice Address - Phone:407-847-2103
Practice Address - Fax:407-847-5042
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL129751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36804OtherBCBS