Provider Demographics
NPI:1366016529
Name:THOMPSON, KIMBERLY MICHELLE (RADIOLOGY)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RADIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3014
Mailing Address - Country:US
Mailing Address - Phone:513-357-7383
Mailing Address - Fax:513-357-7385
Practice Address - Street 1:2750 BEEKMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-2049
Practice Address - Country:US
Practice Address - Phone:513-352-2927
Practice Address - Fax:513-352-3137
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH51.033629126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant