Provider Demographics
NPI:1346465879
Name:THOMSON, SHIBU (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIBU
Middle Name:
Last Name:THOMSON
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 1:1400 SUNSET LN
Mailing Address - Street 2:SUITE 4210
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3300
Mailing Address - Country:US
Mailing Address - Phone:540-825-9132
Mailing Address - Fax:540-825-7587
Practice Address - Street 1:1400 SUNSET LN
Practice Address - Street 2:SUITE 4210
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3300
Practice Address - Country:US
Practice Address - Phone:540-825-9132
Practice Address - Fax:540-825-7587
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice