Provider Demographics
NPI:1376091504
Name:THOMPSON, CAROLYN JO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:JO
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N RIOS AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1242
Mailing Address - Country:US
Mailing Address - Phone:920-368-4667
Mailing Address - Fax:
Practice Address - Street 1:1445 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2931
Practice Address - Country:US
Practice Address - Phone:760-942-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107088122300000X
FLDN22158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist